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9780073019727

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

by
  • ISBN13:

    9780073019727

  • ISBN10:

    0073019720

  • Edition: 4th
  • Format: Paperback
  • Copyright: 2004-08-09
  • Publisher: Career Education
  • View Upgraded Edition
  • Purchase Benefits
List Price: $109.35

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.

Table of Contents

Preface viii
Acknowledgments x
From Patient to Payment
2(18)
Introduction to Medical Insurance
4(2)
Common Types of Medical Insurance
6(1)
The Health Care Claim Billing and Payment Cycle
7(7)
Professional Focus: The Internet and Medical Insurance
13(1)
The Responsibilities of a Medical Insurance Specialist
14(1)
Effects of Health Care Claim Errors
15(5)
HIPAA and the Legal Medical Record
20(20)
Medical Records
22(4)
Protected Health Information and Medical Records
26(7)
Professional Focus: Office of Civil Rights
30(3)
Record Retention
33(1)
Avoiding Fraud
34(6)
Professional Focus: Compliance Plans
35(5)
Diagnostic Coding
40(20)
Introduction to Diagnostic Coding
42(1)
Coding Basics for Physician Practices
43(2)
Using the ICD
45(5)
Five Steps to Diagnostic Coding
50(10)
Professional Focus: Preview of ICD-10-CM
55(5)
Procedural Coding
60(16)
Introduction to Procedure Codes in the CPT
62(2)
Coding Evaluation and Management Services
64(2)
Professional Focus: Certification as a Medical Coder
66(1)
Coding Surgical Procedures
66(1)
Coding Laboratory Procedures
67(1)
Coding Immunizations
67(1)
HCPCS Codes
68(1)
Five Steps for Locating Correct CPT Codes
68(8)
Payment Methods: Managed Care and Indemnity Plans
76(14)
Types of Health Plans
78(3)
Professional Focus: Working as a Medical Insurance Specialist
81(1)
Setting Fees
81(1)
Payment Methods
82(2)
Patients' Charges
84(6)
Health Care Claim Preparation and Transmission
90(26)
Claims Preparation Using Medical Billing Programs
92(2)
Accuracy and Security Issues
94(2)
Professional Focus: Billing Services
96(1)
Types of Claims
96(1)
Preparing HIPAA Claims
97(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

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