Guide to Advanced Medical Billing: A Reimbursement Approach, 3rd edition

SECTION I: INTRODUCTION TO ISSUES RELATED TO HEALTH CLAIMS PROCESSING

1. Introduction to Technical and Legal Issues

2. Resource Manuals and Billing Forms

SECTION II: CONTRACT INTERPRETATION AND ADMINISTRATION

3. Medical Plan Provisions

4. Medical Benefit

SECTION III: MEDICAL CLAIMS EXAMINING GUIDELINES AND PROCEDURES

5. Medical Claims Administration

6. Physician's, Clinical, and Hospital Services Claims

7. Surgery and Anesthesia Claims

8. Medicare and Medicaid

9. Workers' Compensation

10. Managed Care Claims

SECTION IV: MANAGEMENT OF CLAIMS EXAMINING

11. Claims Examination

12. Processing Non-Medicare Claims

13. Processing Medicare Claims

14. Processing Workers' Compensation Claims

SECTION V: APPENDICES