From Patient to Payment : Insurance Procedures for the Medical Office with CD-ROM and Student Data Disk

by Newby, Cynthia

Edition:

4th

ISBN13:

9780073019727

ISBN10:

0073019720

Format:

Paperback

Pub. Date:

8/9/2004

Publisher(s):

Career Education

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Summary

This concise, practical text-workbook provides extensive real-world practice with the HIPAA 837 electronic claim form and CMS 1500 paper claims. Includes flow charts, claims processing forms, and medical reports. Coding and billing content is based on industry practice and addresses electronic claims and a variety of compliance issues. The text provides a brief introduction to NDCMedisoft Advanced, Version 9 software.

Preface

viii

Acknowledgments

From Patient to Payment

(18)

Introduction to Medical Insurance

(2)

Common Types of Medical Insurance

(1)

The Health Care Claim Billing and Payment Cycle

(7)

Professional Focus: The Internet and Medical Insurance

(1)

The Responsibilities of a Medical Insurance Specialist

(1)

Effects of Health Care Claim Errors

(5)

HIPAA and the Legal Medical Record

(20)

Medical Records

(4)

Protected Health Information and Medical Records

(7)

Professional Focus: Office of Civil Rights

(3)

Record Retention

(1)

Avoiding Fraud

(6)

Professional Focus: Compliance Plans

(5)

Diagnostic Coding

(20)

Introduction to Diagnostic Coding

(1)

Coding Basics for Physician Practices

(2)

Using the ICD

(5)

Five Steps to Diagnostic Coding

(10)

Professional Focus: Preview of ICD-10-CM

(5)

Procedural Coding

(16)

Introduction to Procedure Codes in the CPT

(2)

Coding Evaluation and Management Services

(2)

Professional Focus: Certification as a Medical Coder

(1)

Coding Surgical Procedures

(1)

Coding Laboratory Procedures

(1)

Coding Immunizations

(1)

HCPCS Codes

(1)

Five Steps for Locating Correct CPT Codes

(8)

Payment Methods: Managed Care and Indemnity Plans

(14)

Types of Health Plans

(3)

Professional Focus: Working as a Medical Insurance Specialist

(1)

Setting Fees

(1)

Payment Methods

(2)

Patients' Charges

(6)

Health Care Claim Preparation and Transmission

(26)

Claims Preparation Using Medical Billing Programs

(2)

Accuracy and Security Issues

(2)

Professional Focus: Billing Services

(1)

Types of Claims

(1)

Preparing HIPAA Claims

(5)

Transmitting HIPAA Claims

102

(2)

Preparing Paper Claims

104

(12)

Payment Follow-Up and Collections

116

(18)

Health Plan Claim Processing

118

(4)

Professional Focus: Career Opportunities with Health Plans

122

(1)

Processing the Remittance Advice

122

(2)

Appeals

124

(1)

Patient Billing and Collections

125

(9)

Professional Focus: Career Opportunities in Collections

130

(4)

Blue Cross and Blue Shield

134

(12)

Introduction to Blue Cross and Blue Shield

136

(1)

Federal Employee Health Benefits Plan

136

(1)

Key Features of Blue Cross and Blue Shield Plans

137

(1)

Physician Participation and Reimbursement

138

(1)

Filing Claims for Special Cases and National Groups

138

(1)

BlueCard Worldwide

139

(1)

Membership Card Information

139

(1)

Filing Deadlines

140

(6)

Professional Focus: Blue Cross and Blue Shield

140

(6)

Medicare

146

(18)

Medicare Overview

148

(3)

Medicare Charges

151

(1)

Filing Medicare Claims

152

(3)

Professional Focus: Medicare's National Correct Coding Initiative

153

(2)

Who Pays First?

155

(9)

Medicaid

164

(12)

Introduction to Medicaid

166

(1)

Medicaid Coverage

166

(2)

Professional Focus: Medicaid Fraud and Abuse

168

(1)

Medicaid Eligibility

168

(1)

Filing Medicaid Claims

169

(7)

Tricare and Champva

176

(14)

TRICARE

178

(2)

Professional Focus: TRICARE and the HIPAA Privacy Rule

179

(1)

CHAMPVA

180

(1)

Beneficiary Identification

180

(1)

Billing Beneficiaries

181

(1)

Primary or Secondary Payer?

182

(8)

Workers' Compensation

190

(12)

When Employees Are Hurt at Work

192

(1)

Federal Programs, Forms, and Procedures

192

(1)

Professional Focus: Workers' Compensation Terminology

193

(1)

State Programs, Forms, and Procedures

193

(3)

Keeping Separate Records

196

(6)

Disability

202

(8)

Replacing Lost Income

204

(1)

Filing for Disability Benefits

205

(5)

Professional Focus: Consulting and Educational Career Opportunities

207

(3)

Dental Insurance

210

(14)

Introduction to Dental Terms

212

(2)

Dental Insurance

214

(1)

Professional Focus: Dental Injury Claims and Workers' Compensation

215

(1)

Processing Dental Claims

215

(9)

Hospital Insurance

224

(14)

Health Care Facilities: Inpatient versus Outpatient

226

(1)

Hospital Claims Processing

227

(3)

Inpatient (Hospital) Coding

230

(1)

Payers and Payment Methods

231

(1)

Claims and Follow-Up

232

(6)

Professional Focus: Career Opportunities in Hospitals

235

(3)

NDCMediSoft Claim Simulations

238

(30)

Part I Introduction to MediSoft

239

(8)

Part II Guided Claim Simulations

247

(15)

Part III Claim Simulations

262

(6)

Glossary

268

(16)

Index

284

From Patient to Payment : Insurance Procedures for the Medical Office with CD-ROM and Student Data Disk

9780073019727

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Table of Contents