Exercises for Coding and Reimbursement

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  • Edition: 2nd
  • Format: Paperback
  • Copyright: 10/27/2006
  • Publisher: Pearson

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Welcome to the exciting world of medical billing and health claims examining. This book is designed to help the student gain the real life experience of a medical biller and health claims examiner through a simulated work practice.The straightforward easy-to-understand writing style presents information clearly and concisely. Patient and provider names, diagnoses, exercises and examples in this training material have been designed to incorporate a light-hearted humorous context. We have found that humorous writing improves the ability to comprehend and retain information.

Table of Contents

Introductionp. 1
Getting Startedp. 2
Entering a Claim "Into a Computer System"p. 2
Medical Billingp. 2
Health Claims Examiningp. 2
Let's Begin Medical Billingp. 3
Medical Billing Guidelinesp. 4
Setting Up Your "Office"p. 4
Deposit Envelopep. 4
Patient Filesp. 4
p. 4
p. 4
p. 4
Last Fastenerp. 4
Training Tipp. 5
Let's Begin Health Claims Examiningp. 5
Health Claims Examining Guidelinesp. 6
Setting Up Your "Desk"p. 7
Family Filesp. 7
Entire Familyp. 7
Insuredp. 7
Spousep. 7
Dependent Datap. 7
Training Tip
Physicians' Servicesp. 8
p. 8
Family Data Table (Espinosa Family) (Document 1)p. 9
Family Data Table (Smith Family) (Document 2)p. 10
Family Data Table (Parker Family) (Document 3)p. 11
p. 12
p. 12
p. 12
p. 12
Beginning Financials (Espinosa Family) (Document 4)p. 13
Encounter Form (Evelyn Espinosa) (Document 5)p. 13
Encounter Form (Elisa Espinosa) (Document 6)p. 14
Encounter Form (Eva Espinosa) (Document 7)p. 14
Encounter Form (Evan Espinosa) (Document 8)p. 15
Encounter Form (Evan Espinosa) (Document 9)p. 15
Beginning Financials (Smith Family) (Document 10)p. 16
Encounter Form (Sharon Smith) (Document 11)p. 16
Encounter Form (Steve Smith) (Document 12)p. 17
Encounter Form (Sharon Smith) (Document 13)p. 17
Encounter Form (Sam Smith) (Document 14)p. 18
Encounter Form (Sharon Smith) (Document 15)p. 18
Beginning Financials (Parker Family) (Document 16)p. 19
Encounter Form (Patricia Parker) (Document 17)p. 19
Encounter Form (Peter Parker) (Document 18)p. 20
Encounter Form (Pauline Parker) (Document 19)p. 20
Encounter Form (Peter Parker) (Document 20)p. 21
Encounter Form (Pauline Parker) (Document 21)p. 21
p. 22
p. 22
Diagnostic X-Ray and Laboratory Servicesp. 23
p. 23
Family Data Table (Green Family) (Document 22)p. 24
Family Data Table (Francisco Family) (Document 23)p. 25
Family Data Table (Hernandez Family) (Document 24)p. 26
p. 27
p. 27
p. 27
p. 27
Beginning Financials (Green Family) (Document 25)p. 28
Encounter Form (George Green) (Document 26)p. 28
Encounter Form (Greg Green) (Document 27)p. 29
Encounter Form (Gina Green) (Document 28)p. 29
Encounter Form (Greta Green) (Document 29)p. 30
Encounter Form (George Green) (Document 30)p. 30
Beginning Financials (Francisco Family) (Document 31)p. 31
Encounter Form (Frank Francisco) (Document 32)p. 31
Encounter Form (Felicia Francisco) (Document 33)p. 32
Encounter Form (Fred Francisco) (Document 34)p. 32
Encounter Form (Felicia Francisco) (Document 35)p. 33
Encounter Form (Freda Francisco) (Document 36)p. 33
Beginning Financials (Hernandez Family) (Document 37)p. 34
Encounter Form (Hector Hernandez) (Document 38)p. 34
Encounter Form (Hortencia Hernandez) (Document 39)p. 35
Encounter Form (Hector Hernandez) (Document 40)p. 35
Encounter Form (Hortencia Hernandez) (Document 41)p. 36
Encounter Form (Henriquez Hernandez) (Document 42)p. 36
p. 37
p. 37
Surgery Servicesp. 38
p. 38
Family Data Table (Gates Family) (Document 43)p. 39
Family Data Table (Butler Family) (Document 44)p. 40
Family Data Table (Smith Family) (Document 45)p. 41
p. 42
p. 42
p. 42
p. 42
Beginning Financials (Gates Family) (Document 46)p. 43
Encounter Form (Guadalupe Gates) (Document 47)p. 43
Encounter Form (Guadalupe Gates) (Document 48)p. 44
Encounter Form (Gloria Gates) (Document 49)p. 44
Encounter Form (Guillermo Gates) (Document 50)p. 45
Encounter Form (Guillermo Gates) (Document 51)p. 45
Beginning Financials (Butler Family) (Document 52)p. 46
Encounter Form (Barbara Butler) (Document 53)p. 46
Encounter Form (Branford Butler) (Document 54)p. 47
Encounter Form (Brielle Butler) (Document 55)p. 47
Encounter Form (Brielle Butler) (Document 56)p. 48
Encounter Form (Branford Butler) (Document 57)p. 48
Beginning Financials (Smith Family) (Document 58)p. 49
Encounter Form (Sheryl Smith) (Document 59)p. 49
Encounter Form (Shane Smith) (Document 60)p. 50
Encounter Form (Shawn Smith) (Document 61)p. 50
Encounter Form (Sheryl Smith) (Document 62)p. 51
Encounter Form (Shane Smith) (Document 63)p. 51
p. 52
p. 52
Multiple Surgery Servicesp. 53
p. 53
Family Data Table (Thompson Family) (Document 64)p. 54
Family Data Table (Martin Family) (Document 65)p. 55
p. 56
p. 56
p. 56
p. 56
Beginning Financials (Thompson Family) (Document 66)p. 57
Encounter Form (Tony Thompson) (Document 67)p. 57
Encounter Form (Terry Thompson) (Document 68)p. 58
Encounter Form (Traci Thompson) (Document 69)p. 58
Encounter Form (Tony Thompson) (Document 70)p. 59
Encounter Form (Tina Thompson) (Document 71)p. 59
Beginning Financials (Martin Family) (Document 72)p. 60
Encounter Form (Mark Martin) (Document 73)p. 60
Encounter Form (Melissa Martin) (Document 74)p. 61
Encounter Form (Maria Martin) (Document 75)p. 61
Encounter Form (Melody Martin) (Document 76)p. 62
Encounter Forms (Maria Martin) (Document 77)p. 62
p. 63
p. 63
Assistant Surgery Servicesp. 64
p. 64
Family Data Table (Dodson Family) (Document 78)p. 65
Family Data Table (Westin Family) (Document 79)p. 66
Family Data Table (Smith Family) (Document 80)p. 67
p. 68
p. 68
p. 68
p. 68
Beginning Financials (Dodson Family) (Document 81)p. 69
Encounter Form (Doris Dodson) (Document 82)p. 69
Encounter Form (Debbie Dodson) (Document 83)p. 70
Encounter Form (Daniel Dodson) (Document 84)p. 70
Encounter Form (Deedee Dodson) (Document 85)p. 71
Encounter Form (Daniel Dodson) (Document 86)p. 71
Beginning Financials (Westin Family) (Document 87)p. 72
Encounter Form (William Westin) (Document 88)p. 72
Encounter Form (Wilma Westin) (Document 89)p. 73
Encounter Form (Wilma Westin) (Document 90)p. 73
Encounter Form (Wendy Westin) (Document 91)p. 74
Encounter Form (William Westin) (Document 92)p. 74
Beginning Financials (Smith Family) (Document 93)p. 75
Encounter Form (Sherman Smith) (Document 94)p. 75
Encounter Form (Sherry Smith) (Document 95)p. 76
Encounter Form (Sherry Smith) (Document 96)p. 76
Encounter Form (Sean Smith) (Document 97)p. 77
Encounter Form (Sherman Smith) (Document 98)p. 77
p. 78
p. 78
Anesthesia Servicesp. 79
p. 79
Family Data Table (Norton Family) (Document 99)p. 80
p. 81
p. 81
p. 81
p. 81
Beginning Financials (Norton Family) (Document 100)p. 82
Encounter Form (Ned Norton) (Document 101)p. 82
Encounter Form (Nancy Norton) (Document 102)p. 83
Encounter Form (Neil Norton) (Document 103)p. 83
Encounter Form (Nancy Norton) (Document 104)p. 84
Encounter Form (Nina Norton) (Document 105)p. 84
Beginning Financials (Westin Family) (Document 106)p. 85
Encounter Form (Wendy Westin) (Document 107)p. 85
Encounter Form (Wally Westin) (Document 108)p. 86
Encounter Form (William Westin) (Document 109)p. 86
Encounter Form (Wendy Westin) (Document 110)p. 87
Encounter Form (Wilma Westin) (Document 111)p. 87
p. 88
p. 88
Hospital Servicesp. 89
p. 89
Family Data Table (Gonzales Family) (Document 112)p. 90
Family Data Table (Levine Family) (Document 113)p. 91
Family Data Table (Ingles Family) (Document 114)p. 92
Family Data Table (Jennings Family) (Document 115)p. 93
Family Data Table (Fury Family) (Document 116)p. 94
p. 95
p. 95
p. 95
p. 95
Beginning Financials (Gonzales Family) (Document 117)p. 96
Hospital Admission Form (Gary Gonzales) (Document 118)p. 96
Hospital Itemization Documents (Document 118)p. 97
Hospital Admission Form (Genara Gonzales) (Document 119)p. 100
Hospital Itemization Documents (Document 119)p. 101
Hospital Admission Form (Ginnie Gonzales) (Document 120)p. 104
Hospital Itemization Document (Document 120)p. 105
Hospital Admission Form (Gary Gonzales, Jr.) (Document 121)p. 108
Hospital Itemization Document (Document 121)p. 109
Hospital Admission Form (Grace Gonzales) (Document 122)p. 112
Hospital Itemization Document (Document 122)p. 113
Beginning Financials (Levine Family) (Document 123)p. 116
Hospital Admission Form (Larry Levine) (Document 124)p. 116
Hospital Itemization Document (Document 124)p. 117
Hospital Admission Form (Lannie Levine) (Document 125)p. 118
Hospital Itemization Documents (Document 125)p. 119
Hospital Admission Form (Lloyd Levine) (Document 126)p. 121
Hospital Itemization Document (Document 126)p. 122
Hospital Admission Form (Lisa Levine) (Document 127)p. 124
Hospital Itemization Documents (Document 127)p. 125
Hospital Admission Form (Lila Levine) (Document 128)p. 126
Hospital Itemization Document (Document 128)p. 127
Beginning Financials (Ingles Family) (Document 129)p. 128
Hospital Admission Form (Inez Ingles) (Document 130)p. 128
Hospital Itemization Documents (Document 130)p. 129
Hospital Admission Form (Irving Ingles) (Document 131)p. 134
Hospital Itemization Document (Document 131)p. 135
Hospital Admission Form (Irma Ingles) (Document 132)p. 136
Hospital Itemization Document (Document 132)p. 137
Hospital Admission Form (Inez Ingles) (Document 133)p. 138
Hospital Itemization Document (Document 133)p. 139
Hospital Admission Form (Ilene Ingles) (Document 134)p. 140
Hospital Itemization Document (Document 134)p. 141
Beginning Financials (Jennings Family) (Document 135)p. 142
Hospital Admission Form (Jacqueline Jennings) (Document 136)p. 142
Hospital Itemization Document (Document 136)p. 143
Hospital Admission Form (Julia Jennings) (Document 137)p. 144
Hospital Itemization Documents (Document 137)p. 145
Hospital Admission Form (Jack Jennings) (Document 138)p. 148
Hospital Itemization Document (Document 138)p. 149
Hospital Admission Form (Jennifer Jennings) (Document 139)p. 150
Hospital Itemization Documents (Document 139)p. 151
Hospital Admission Form (Baby Boy Jennings) (Document 140)p. 153
Hospital Itemization Documents (Document 140)p. 154
Hospital Admission Form (Janet Jennings) (Document 141)p. 156
Hospital Itemization Documents (Document 141)p. 157
Beginning Financials (Fury Family) (Document 142)p. 160
Hospital Admission Form (Fay Fury) (Document 143)p. 160
Hospital Itemization Documents (Document 143)p. 161
Utilization Review Certification (Document 143)p. 166
Hospital Admission Form (Fay Fury) (Document 144)p. 167
Hospital Itemization Documents (Document 144)p. 168
Utilization Review Certification (Document 144)p. 171
Hospital Admission Form (Fred Fury) (Document 145)p. 172
Hospital Itemization Documents (Document 145)p. 173
Utilization Review Certification (Document 145)p. 177
Hospital Admission Form (Fern Fury) (Document 146)p. 178
Hospital Itemization Documents (Document 146)p. 179
Utilization Review Certification (Document 146)p. 185
Hospital Admission Form (Forrest Fury) (Document 147)p. 186
Hospital Itemization Documents (Document 147)p. 187
Utilization Review Certification (Document 147)p. 191
p. 192
p. 192
Coordination of Benefitsp. 193
p. 193
Family Data Table (Brown Family) (Document 148)p. 194
Family Data Table (Allred Family) (Document 149)p. 195
Family Data Table (Innman Family) (Document 150)p. 196
p. 197
p. 197
p. 197
p. 197
Beginning Financials (Brown Family) (Document 151)p. 198
Encounter Form (Bobby Brown) (Document 152)p. 198
Explanation of Medical Benefits (Document 152)p. 199
Encounter Form (Bernice Brown) (Document 153)p. 200
Explanation of Medical Benefits (Document 153)p. 201
Encounter Form (Bernice Brown) (Document 154)p. 202
Explanation of Medical Benefits (Document 154)p. 203
Patient Claim Form (Bernice Brown) (Document 155)p. 204
Explanation of Medical Benefits (Document 155)p. 207
Encounter Form (Brenda Brown) (Document 156)p. 208
Explanation of Medical Benefits (Document 156)p. 209
Hospital Admission Form (Bobby Brown) (Document 157)p. 210
Hospital Itemization Document (Document 157)p. 211
Explanation of Medical Benefits (Document 157)p. 212
Encounter Form (Bobby Brown) (Document 158)p. 213
Explanation of Medical Benefits (Document 158)p. 214
Explanation of Medical Benefits (Document 158)p. 215
Beginning Financials (Allred Family) (Document 159)p. 216
Encounter Form (Allison Allred) (Document 160)p. 216
Explanation of Medical Benefits (Document 160)p. 217
Encounter Form (Allison Allred) (Document 161)p. 218
Explanation of Medical Benefits (Document 161)p. 219
Hospital Admission Form (Allen Allred) (Document 162)p. 220
Hospital Itemization Document (Document 162)p. 221
Explanation of Medical Benefits (Document 162)p. 222
Encounter Form (Ann Allred) (Document 163)p. 223
Explanation of Medical Benefits (Document 163)p. 224
Hospital Admission Form (Allison Allred) (Document 164)p. 225
Hospital Itemization Document (Document 164)p. 226
Explanation of Medical Benefits (Document 164)p. 227
Beginning Financials (Innman Family) (Document 165)p. 228
Hospital Admission Form (Ingrid Innman) (Document 166)p. 228
Hospital Itemization Document (Document 166)p. 229
Explanation of Medical Benefits (Document 166)p. 230
Encounter Form (Ingrid Innman) (Document 167)p. 231
Explanation of Medical Benefits (Document 167)p. 232
Patient Claim Form (Ingrid Innman) (Document 168)p. 233
Explanation of Medical Benefits (Document 168)p. 236
Encounter Form (Ian Innman) (Document 169)p. 237
Explanation of Medical Benefits (Document 169)p. 238
Hospital Admission Form (Ian Innman) (Document 170)p. 239
Hospital Itemization Document (Document 170)p. 240
Explanation of Medical Benefits (Document 170)p. 241
p. 242
p. 242
Medicare and Medicaid Servicesp. 243
p. 243
Family Data Table (Vaughn Family) (Document 171)p. 244
Family Data Table (Conners Family) (Document 172)p. 245
Family Data Table (Hanaka Family) (Document 173)p. 246
p. 247
p. 247
p. 247
p. 247
p. 248
p. 249
Beginning Financials (Vaughn Family) (Document 174)p. 250
Encounter Form (Vernon Vaughn) (Document 175)p. 250
Encounter Form (Vernon Vaughn) (Document 176)p. 251
Encounter Form (Vernon Vaughn) (Document 177)p. 251
Encounter Form (Vicki Vaughn) (Document 178)p. 252
Encounter Form (Vicki Vaughn) (Document 179)p. 252
Beginning Financials (Conners Family) (Document 180)p. 253
Encounter Form (Chris Conners) (Document 181)p. 253
Encounter Form (Clara Conners) (Document 182)p. 254
Encounter Form (Clara Conners) (Document 183)p. 254
Hospital Admission Form (Chris Conners) (Document 184)p. 255
Hospital Itemization Document (Document 184)p. 256
Hospital Admission Form (Chris Conners) (Document 185)p. 257
Hospital Itemization Document (Document 185)p. 258
Beginning Financials (Hanaka Family) (Document 186)p. 259
Encounter Form (Hiro Hanaka) (Document 187)p. 259
Encounter Form (Hiro Hanaka) (Document 188)p. 260
Encounter Form (Holly Hanaka) (Document 189)p. 260
Hospital Admission Form (Holly Hanaka) (Document 190)p. 261
Hospital Itemization Document (Document 190)p. 262
Encounter Form (Holly Hanaka) (Document 191)p. 263
p. 264
p. 264
Medicare Remittance Notice (Document 192)p. 265
Medicare Remittance Notice (Document 192)p. 266
Miscellaneous Servicesp. 267
p. 267
Family Data Table (Rubble Family) (Document 193)p. 268
Family Data Table (Minnetoma Family) (Document 194)p. 269
Family Data Table (Talawan Family) (Document 195)p. 270
p. 271
p. 271
p. 271
p. 271
Beginning Financials (Rubble Family) (Document 196)p. 272
Encounter Form (Raisa Rubble) (Document 197)p. 272
Encounter Form (Raisa Rubble) (Document 198)p. 273
Encounter Form (Renee Rubble) (Document 199)p. 273
Encounter Form (Royal Rubble) (Document 200)p. 274
Encounter Form (Renee Rubble) (Document 201)p. 274
Beginning Financials (Minnetoma Family) (Document 202)p. 275
Encounter Form (Monty Minnetoma) (Document 203)p. 275
Encounter Form (Monty Minnetoma) (Document 204)p. 276
Encounter Form (Melanie Minnetoma) (Document 205)p. 276
Encounter Form (Morey Minnetoma) (Document 206)p. 277
Encounter Form (Melanie Minnetoma) (Document 207)p. 277
Beginning Financials (Talawan Family) (Document 208)p. 278
Encounter Form (Taura Talawan) (Document 209)p. 278
Encounter Form (Tabari Talawan) (Document 210)p. 279
Encounter Form (Tabari Talawan) (Document 211)p. 279
Encounter Form (Taura Talawan) (Documents 212)p. 280
Encounter Form (TiRon Talawan) (Documents 213)p. 280
p. 281
p. 281
Formsp. 282
Patient Information Sheetp. 283
Ledger Card/Statement of Accountp. 287
Insurance Coverage Formp. 291
Patient Receiptsp. 295
Deposit Slip/Ticketp. 299
Insurance Claims Registerp. 303
Insurance Tracerp. 307
Charge Slipp. 311
Treatment Authorization Requestp. 315
Stationery (Any Billing Services)p. 319
Request for Additional Information Formp. 323
Payment Worksheetp. 327
Family Benefit Tracking Sheetp. 331
Coordination of Benefits Calculation Worksheetp. 335
Stationery (Any Insurance Carrier, Inc.)p. 339
Request for Additional Information Formsp. 343
Contracts, UCR & RVSp. 351
ABC Corporation/Winter Insurance Companyp. 353
Ninja Enterprises/Rover Insurers, Inc.p. 355
XYZ Corporation/Ball Insurance Carriersp. 357
UCR Conversion Factor Reportp. 359
Relative Value Studyp. 371
Assistant Surgeon Procedurep. 382
Network Provider Listp. 383
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