Comprehensive Health Insurance

Description

Hallmark features of this title

Practical skill-building

• Step-by-step organization, across chapters, takes students through each stage of the medical billing process. Chapters build upon one another to connect concepts.
• Examples and professional tips reinforce best practices in billing and coding.
• Crucial HIPAA material is detailed in Chapter 4, ensuring familiarity with this “need to know” law.

Active-learning opportunities

• Hands-on practice exercises help students master skills, retain information and stay engaged.
• Case studies with critical-thinking questions offer glimpses into real-world scenarios, while honing decision-making skills.
• Chapter objectives, introductions, summaries and reviews help students build comprehension and focus their studies.

SECTION I: A CAREER IN HEALTH CARE

1. Introduction to Professional Billing and Coding Careers

SECTION II: THE RELATIONSHIP BETWEEN THE PATIENT, PROVIDER, AND CARRIER

2. Understanding Managed Care: Insurance Plans
3. Understanding Managed Care: Medical Contracts and Ethics
4. Introduction to the Health Insurance Portability and Accountability Act (HIPAA)

SECTION III: MEDICAL CODING

5. ICD-10-CM Medical Coding
6. Introduction to CPT and Place of Service Coding
7. Coding Procedures and Services
8. HCPCS and Coding Compliance
9. Auditing

SECTION IV: MEDICAL CLAIMS

10. Physician Medical Billing
11. Hospital Medical Billing

SECTION V: GOVERNMENT MEDICAL BILLING

12. Medicare Medical Billing
13. Medicaid Medical Billing
14. TRICARE Medical Billing

SECTION VI: ACCOUNTS RECEIVABLE

15. Explanation of Benefits and Payment Adjudication
16. Refunds, Follow-Up, and Appeals

SECTION VII: INJURED EMPLOYEE MEDICAL CLAIM

17. Workers’ Compensation

APPENDICES

1. Completing the CMS-1500 Form for Physician Outpatient Billing
2. Completing the CMS-1500 Form for Physician Outpatient Billing Plus Determining the Correct Diagnostic and Procedure Codes
3. Completing the UB-04 Form for Hospital Billing
4. Medical Forms
5. Acronyms and Abbreviations
6. Medical Terminology Word Parts
7. Helpful Websites

About our authors

Deborah Vines has worked extensively for over 30 years in the healthcare industry as a practice administrator and manager in physical therapy, dermatopathology and pediatrics. She has also held management positions in the hospital setting. As director of operations for a national healthcare staffing corporation, she has traveled across the United States, working directly with physicians and medical human resources personnel to secure jobs for individuals in the medical billing, coding and collection fields. One of Ms. Vines’s mentionable achievements is that in one fiscal year, through mentoring and training, she assisted 300 recruits to find employment in the medical billing industry. This achievement led her to open the Allied Career Center in Dallas, Texas, a successful vocational school specializing in medical office specialist training.

Ann Braceland, NCICS, has been working in the medical field since graduating from Gwynedd Mercy College with an associate’s degree in nursing science. As a practice manager, her extensive work in managed care and medical billing and coding has allowed her to research and find means of informing others through her teaching of the changes and challenges that arise in the medical field. Mrs. Braceland has established and managed satellite offices in physical and occupational medicine. She is a Medicare representative with a vast spectrum of knowledge that she uses to train staff and physicians in compliance coding and billing. As director of training for the instructors of Allied Career Center in Dallas, Texas, her presentation of the material for students led to the publication of this book. Mrs. Braceland is a National Certified Insurance and Coding Specialist.

Susan Miller has worked in the health care industry for 25 years, managing and supervising medical billing processes. She has lectured in a classroom setting, providing students with knowledge and skills on medical billing and coding. Ms. Miller continues her health care career in medical billing, providing support to staff members on billing and coding guidelines.

New and updated features of this title

Trends in health care

• UPDATED: Highlighted trends in health care include care delivery models, innovation driven by competition, new technologies, rising costs and an expansion of patients, both insured and uninsured.
• UPDATED: Discussions of the Affordable Care Act touch on the bill’s impact on insurance and billing, as well as the Medicaid expansion program (Ch. 13).
• NEW: Concierge medicine and telemedicine are explored as new methods of healthcare treatment and cost savings.

Updated practice and resources

• UPDATED: 2017 ICD-10, CPT and HCPCS codes are drawn on throughout all coding content and exercises. Chapter 5 addresses revisions to ICD coding that add specificity to patient health problems.
• UPDATED: The new CMS-1500 form is reviewed in detail. All related exercises and examples include the 02-2012 form, the standard Medicare and Medicaid claim form required by CMS.
• EXPANDED: New figures and tables illustrate key concepts, helping students make connections between important ideas.

For courses in Introduction to Healthcare Billing and Medical Coding

A clear illustration of the key health insurance concepts students need to learn to be workplace ready
Comprehensive Health Insurance: Billing, Coding, and Reimbursement provides students with the knowledge and skills needed to work in a variety of administrative positions in the medical field. It covers the foundations of insurance, billing, coding, and reimbursement, offering a comprehensive view of how each element in the process affects all other steps. Students learn not only the submission of claims to the insurance carrier, but also reviewing medical records, verifying patient benefits, submitting a secondary claim, posting payments and appealing the insurance carrier’s decision. Numerous case studies and patient files are included throughout to demonstrate refunds and appeals, auditing, and compliance, Medicare calculations, and professionalism. The Third Edition includes 2017 ICD-10, CPT, and HCPCS codes; information about the ramifications of the Affordable Care Act; and current information on health care changes, trends, and the future of health care.

Also available with MyLab Health Professions for the Comprehensive Health Insurance course

MyLab™ is an online homework, tutorial, and assessment program designed to work with this text to engage students and improve results. Within its structured environment, students have ample opportunity to practice what they learn and test their understanding to better absorb course material and understand difficult concepts.

Students, if interested in purchasing this title with MyLab, ask your instructor for the correct package ISBN and Course ID. Instructors, contact your Pearson representative for more information.

Comprehensive Health Insurance: Billing, Coding, and Reimbursement is your how-to guide to key health insurance concepts. You’ll learn key medical administrative tasks, from submitting claims and verifying benefits to posting payments and appealing claim denials. Using a step-by-step approach, the authors cover the foundations and interconnection of insurance policy, billing, coding and reimbursement. Case studies and patient files contextualize and simplify the many complexities of health care.

The 3rd Edition includes 2017 ICD-10, CPT and HCPCS codes. It assesses the impact of the Affordable Care Act, while examining health care trends such as care delivery models and innovation driven by competition. Concierge medicine and telemedicine are explored as new methods of healthcare treatment and cost savings.

Additional information

Dimensions	1.20 × 8.45 × 10.90 in
Imprint	Pearson
Format	gen
ISBN-13	09780134458779
ISBN-10	013445877X
Author	Susan Miller, Deborah Vines, Ann Braceland, Elizabeth Rollins
Subjects	higher education, Vocational / Professional Studies, Health Professions, Medical Insurance, Billing and Coding, Medical Billing and Coding