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

Published by Pearson (September 18, 2020) © 2018

  • Deborah Vines
  • Ann Braceland
  • Elizabeth Rollins
  • Susan Miller
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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.

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

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

SECTION III: MEDICAL CODING

  1. ICD-10-CM Medical Coding
  2. Introduction to CPT and Place of Service Coding
  3. Coding Procedures and Services
  4. HCPCS and Coding Compliance
  5. Auditing

SECTION IV: MEDICAL CLAIMS

  1. Physician Medical Billing
  2. Hospital Medical Billing

SECTION V: GOVERNMENT MEDICAL BILLING

  1. Medicare Medical Billing
  2. Medicaid Medical Billing
  3. TRICARE Medical Billing

SECTION VI: ACCOUNTS RECEIVABLE

  1. Explanation of Benefits and Payment Adjudication
  2. Refunds, Follow-Up, and Appeals

SECTION VII: INJURED EMPLOYEE MEDICAL CLAIM

  1. 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

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