Comprehensive Health Insurance: Billing, Coding, and Reimbursement, 3rd edition

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