Understanding Health Insurance, A Guide to Professional Billing

Seventh Edition
Author: Jo Ann C. Rowell; Michelle Green
ISBN #: 1401837913
©2004   Publish Date: 07/16/2003
Binding: PB
Pages: 656
Publisher: Cengage Learning

Price: $189.95

Description:

Understanding Health Insurance: A Guide to Professional Billing, 7th edition, is a comprehensive guide for those learning about health insurance claims processing and reimbursement issues. The text utilizes a step-by-step approach to successful completion of health insurance claims. The objectives of this edition are to 1) introduce information about major third party payers, 2) provide up-to-date information about federal health care regulations, 3) clarify coding guidelines and provide application exercises for each coding system, 4) introduce reimbursement issues, 5) emphasize the importance of coding for medical necessity, and 6) help users develop the skill to complete claims accurately. Numerous examples help clarify key concepts. Case studies and review exercises provide users with numerous opportunities to apply knowledge and develop skills in completing CMS-1500 claims accurately. The textbook CD-ROM and accompanying workbook provide additional exercises and practice in completing CMS-1500 claims electronically. Current information is provided on CPT-5 and ICD-10-CM coding systems. The appendices include information about processing UB-92 (CMS-1450) claims and dental claims.

Product Benefits:

• For each major payer, the text "walks" users through the steps of completing insurance claims
• A "one-stop-shop" approach integrates diagnosis and procedure coding, reimbursement & legal issues, and health insurance claims processing.
• Each insurance payer chapter contains case studies for CMS-1500 completion; chapters contain numerous coding scenarios for practice; and the appendices and text CD-ROM contain additional case studies for practice in CMS-1500 completion (manually and electronically).
• The CD-ROM at the back of the text provides an opportunity for practice in electronic data entry for claims processing purposes. A unique feature of the disk is the three methods by which claims can be entered - blank form mode (just like in a provider's office), self study mode (feedback is provided as data is entered), and test mode (a nice feature for educators who will use the cases as quizzes and examinations during class; in this mode, feedback is provided at the end of data entry of a case). It also contains a ?game shell,? which allows students to review chapter content.
• Appendices provide instruction in electronic data interchange (EDI) and completion of the UB-92 (CMS-1450), the claim used for inpatient and outpatient hospital claims.
• New patient encounter form for all CMS-1500 completion exercises and case studies simplifies extracting information.

Table of Contents:

Preface, Chapter 1 - Health Insurance Specialist—Roles and Responsibilities, Chapter 2 - Introduction to Health Insurance, Chapter 3 - Managed Health Care, Chapter 4 - Life Cycle of an Insurance Claim, Chapter 5 - Legal & Regulatory Considerations, Chapter 6 - ICD-9-CM Coding, Chapter 7 - CPT Coding, Chapter 8 - HCPCS Coding (name change from HCPCS Coding System), Chapter 9 - CMS Reimbursement Issues (name change from HCFA Reimbursement Issues), Chapter 10 - Coding for Medical Necessity (name change from Coding from Source Documents), Chapter 11 - Essential Claims Completion Guidelines (name change from Essential Claim Form Instructions), Chapter 12 - Commercial Claims (name change from Filing Commercial Claims), Chapter 13 - Blue Cross and Blue Shield Plans, Chapter 14 - Medicare, Chapter 15 - Medicaid, Chapter 16 - TRICARE, Chapter 17 - Workers'' Compensation, Appendix I - Case Studies: Set One, Appendix II - Clinic Billing Manual and Case Studies: Set Two, Appendix III - Forms, Appendix IV - Answers to Coding Exercises, Appendix V - Using the UHI Student Practice CD-ROM, Appendix VI - Abbreviations, Appendix VII - Common Medical Terminology Prefixes, Suffixes, and Combining Forms, Appendix VIII - Web Sites, Appendix IX -X - Electronic Data Interchange and the UB-92 (CMS-1450), Appendix X - Dental Claims ProcessingInsurance, Appendix XI - Bibliography, Appendix XII - Glossary

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