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The Guide to Medical Billing and Coding,9780131718494
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The Guide to Medical Billing and Coding

by
Edition:
2nd
ISBN13:

9780131718494

ISBN10:
0131718495
Format:
Paperback
Pub. Date:
1/1/2007
Publisher(s):
Prentice Hall

Questions About This Book?

What version or edition is this?
This is the 2nd edition with a publication date of 1/1/2007.
What is included with this book?
  • The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any CDs, lab manuals, study guides, etc.

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Summary

Ideal for two-year and career college program in medical billing and coding. Practical Guide to what students need to succeed in the job including professionalism, billing and coding skills, and general studies. Written with one goal - to ensure students succeed the first and every day as a medical biller. It is ideal for learning how to perform as a medical biller/coder.

Table of Contents

Introduction
1(18)
The Historical Perspective
2(1)
Job Roles and Duties
2(1)
The Medical Team
2(1)
Types of Healthcare Settings
3(1)
Technology and the Medical Biller
4(1)
Attitudes that Make a Successful Medical Biller
4(2)
Workplace Professionalism
6(1)
Interpersonal Skills
7(1)
Professional Appearance
8(1)
Stress
9(1)
Pre-Vacation Work Planning
10(1)
Detail Orientation
11(1)
Certification Programs for Medical Billers
12(1)
Summary
12(1)
Assignments
12(1)
Questions for Review
13(1)
Exercises 1 -- 1 through 1 -- 3
14(1)
Honors Certification™
15(4)
Time Management and Prioritizing
19(9)
Prioritization
19(2)
Pressure Projects
21(1)
Time Management
22(1)
Counting Time Backwards
23(1)
Overlapping Projects
23(1)
Summary
24(1)
Assignments
24(1)
Questions for Review
24(2)
Exercises 2 -- 1 through 2 -- 2
26(1)
Honors Certification™
27(1)
Legal Issues
28(14)
Privacy Guidelines
28(3)
Fraud
31(1)
HIPAA and Fraud and Abuse
32(1)
Embezzlement
33(1)
Disclaimers
34(1)
Legal Damages
34(1)
Medical Ethics
35(1)
Subpoenas
36(1)
Instances in Which the Patient Should Be Notified and the File Notated
37(2)
Summary
39(1)
Assignments
39(1)
Questions for Review
40(1)
Honors Certification™
41(1)
Clinical Records Management
42(12)
Medical Charts
43(2)
Filing the Chart
45(1)
Medical Documentation Rules
46(1)
Signature Cards
47(1)
Retention of Records
48(1)
Storing Medical Records
49(1)
Electronic Medical Charting
50(1)
Computerized Files
50(1)
Record Transfers
51(1)
Summary
52(1)
Assignments
52(1)
Questions for Review
52(1)
Honors Certification™
53(1)
Medical Documentation Forms
54(11)
Patient Information Sheet
55(1)
Release of Information Form
55(1)
Assignment of Benefits Form
55(5)
Patient History Form
60(1)
Insurance Verification
60(1)
Additional Suggestions
60(2)
Summary
62(1)
Assignments
62(1)
Questions for Review
62(1)
Exercise 5 -- 1
63(1)
Honors Certification™
64(1)
Contract Interpretation
65(25)
Blue Cross/ Blue Shield
66(1)
Contract Provisions
66(2)
Contract Benefits
68(5)
Exclusions
73(1)
Allowed Amounts
73(1)
Pre-Certification of Inpatient Admissions
74(1)
Utilization Review
75(1)
Second Surgical Opinion Consultations
76(1)
Summary
76(1)
Assignments
76(1)
Questions for Review
77(1)
Exercises 6 -- 1 through 6 -- 5
78(5)
Honors Certification™
83(1)
Sample Insurance Contract
84(6)
Medicare
90(26)
Tefra/Defra
91(1)
Medicare Eligibility
92(1)
Providers of Service
92(1)
The Two Parts of Medicare
92(2)
Approved or Reasonable Charges
94(1)
Billing Medicare Services
94(4)
Assignment of Benefits
98(2)
Coordinating Medicare w/Other Insurance
100(1)
Estimating Medicare Coverage
100(1)
Diagnosis-Related Group Billing
101(1)
Medicare Denials
101(1)
Medicare Advance Notice
102(1)
The Medicare Appeals Process
102(4)
Medical Fraud and Abuse
106(2)
Medicare Supplement
108(1)
Medicare and Veterans
108(1)
Medicare and Managed Care
109(2)
Medicare Notice of Non-Coverage
111(1)
Medicare Timeliness Reports
112(2)
Summary
114(1)
Assignments
114(1)
Questions for Review
114(1)
Exercise 7 -- 1
115(1)
Honors Certification™
115(1)
Medicaid
116(7)
Medicaid Billing Procedures
117(1)
Treatment Authorization Request
118(2)
Reimbursement from Medicaid
120(1)
Summary
121(1)
Assignments
122(1)
Questions for Review
122(1)
Honors Certification™
122(1)
Workers' Compensation
123(18)
Employee Activities
124(1)
Time Limits
125(1)
Types of Claims
125(2)
Benefits of Workers' Compensation
127(1)
Workers' Compensation Reform
127(1)
Medical Service Order
128(1)
Patient Records
129(1)
Doctor's First Report
129(2)
Subsequent Progress Reports
131(1)
Physician's Final Report
131(1)
Delay of Adjudication
132(1)
Billing for Workers' Compensation
132(1)
Delinquent Claims
133(1)
Fraud and Abuse
133(2)
Third Party Liability
135(1)
Liens
135(1)
Reversals
136(1)
Summary
136(1)
Assignments
136(3)
Questions for Review
139(1)
Exercise 9-1
140(1)
Honors Certification™
140(1)
Managed Care
141(34)
Rising Health Care Costs
142(1)
Decreasing Costs
143(1)
Managed Care
144(2)
HMO Coverage
146(1)
Preferred Provider Organizations
147(1)
Billing Managed Care
148(3)
Groups/IPAs
151(1)
Capitation Payments
152(3)
Patient Charts
155(1)
HMO Appointment Scheduling
156(2)
Authorizations, Referrals, and Second Opinions
158(1)
Denial of Service to Members
159(2)
Member Grievances and Complaints
161(1)
Transfers
162(1)
Disenrollment
162(1)
Continuing Care
163(1)
Miscellaneous Services
164(1)
Facility Requirements
165(1)
Sanctions
166(1)
Claim Payments
167(6)
Summary
173(1)
Assignments
173(1)
Questions for Review
174(1)
Honors Certification™
174(1)
Miscellaneous Billing Procedures
175(14)
Billing for Service
176(1)
Determining the Proper Billing Amount
177(1)
Billing Forms
177(2)
Additional Suggestions
179(1)
Billing Tips/Issues
179(1)
Special Services
180(1)
Maximum Reimbursement Tips
180(1)
Collecting the Patient Portion
181(1)
Patient Claim form
182(1)
Coordination of Benefits
182(4)
COB With Health Maintenance Organizations
186(1)
Tricare
186(1)
Summary
187(1)
Assignments
187(1)
Questions for Review
187(1)
Exercise 11 -- 1
188(1)
Honors Certification™
188(1)
Patient Accounting
189(14)
Accounts Payable/ Receivable
190(1)
The Ledger Card
190(2)
Insurance Payments
192(1)
Posting Payments
193(1)
Balance Billing
193(1)
Follow-Ups
194(2)
Collections
196(1)
Collections Procedures
197(3)
Small Claims Court
200(1)
Summary
200(1)
Assignments
200(1)
Questions for Review
201(1)
Exercise 12 -- 1
202(1)
Honors Certification™
202(1)
Office Accounting
203(6)
Petty Cash
203(2)
Office Reports
205(2)
Summary
207(1)
Assignments
207(1)
Questions for Review
207(1)
Honors Certification™
208(1)
Terminology
209(13)
Insurance Terminology
209(4)
Provider Abbreviations
213(1)
Medical Abbreviations
214(3)
Medical Symbols
217(1)
Summary
217(1)
Assignments
217(1)
Questions for Review
218(1)
Exercises 14 -- 1 through 14 -- 4
218(3)
Honors Certification™
221(1)
Reference Books
222(9)
ICD-9
222(1)
CPT®/RVS
223(1)
HCPCS
223(1)
Physicians' Desk Reference
223(1)
Medical Dictionary
223(2)
Merck Manual
225(1)
Summary
225(1)
Assignments
225(1)
Questions for Review
226(1)
Exercises 15 -- 1 through 15 -- 4
227(3)
Honors Certification™
230(1)
ICD-9
231(19)
History of the ICD-9
231(1)
Contents of the ICD-9
232(1)
How to Use the ICD-9
233(1)
General Guidelines
233(2)
Main Terms
235(1)
Exceptions
236(2)
V Codes
238(1)
E Codes
239(1)
Signs and Symbols Used in the ICD-D
239(1)
Billing Tips
240(1)
ICD-10
241(1)
Summary
242(1)
Assignments
242(1)
Questions for Review
243(1)
Exercises 16 -- 1 through 16 -- 5
244(5)
Honors Certification™
249(1)
CPT® Coding
250(26)
Using the CPT®
251(1)
Semicolons in the CPT®
251(1)
Signs and Symbols Used in the CPT®
252(1)
Using the CPT® Index
252(1)
Modifiers
252(1)
Unlisted Codes
252(1)
Evaluation and Management Codes
253(2)
Anesthesia
255(1)
Surgery
256(4)
Radiology/X-ray
260(1)
Pathology/Laboratory
260(2)
Medicine
262(3)
Billing Tips
265(1)
Summary
265(1)
Assignments
265(1)
Questions for Review
265(1)
Exercises 17 -- 1 through 17 -- 10
266(9)
Honors Certification™
275(1)
HCPCS Coding
276(16)
General Information
277(1)
Coding Using the HCPCS Manual
278(1)
Sections of the HCPCS Manual
278(1)
Transportation Services
278(2)
Medical and Surgical Supplies
280(1)
Miscellaneous and Experimental
280(1)
Enteral and Parenteral Therapy
280(1)
Temporary Hospital Outpatient PPS
281(1)
Dental Procedures
281(1)
Durable Medical Equipment
282(2)
Procedures and Professional Services
284(1)
Rehabilitative Services
284(1)
Drugs Administered Other than Oral Method
284(1)
Immunosuppressive Drugs
285(1)
Chemotherapy Drugs
285(1)
Temporary Codes for DMERCs
285(1)
Orthotic Procedures
285(1)
Prosthetic Procedures
286(1)
Medical Services
286(1)
Pathology/Laboratory
286(1)
Temporary Codes
286(1)
Diagnostic Radiology Services
286(1)
Private Payer Codes
286(1)
State Medicaid Agency Codes
287(1)
Vision Services
287(1)
Hearing Services
287(1)
Modifiers
287(1)
Summary
287(1)
Assignments
287(1)
Questions for Review
288(1)
Exercises 18 -- 1 through 18 -- 2
289(2)
Honors Certification™
291(1)
Medications and the PDR
292(6)
Generic vs. Brand Name Drugs
292(1)
Service Plans
293(1)
Physicians' Desk Reference
293(1)
Definitions
294(1)
Symbols
294(1)
Summary
294(1)
Assignments
295(1)
Questions for Review
295(1)
Exercises 19 -- 1 through 19 -- 3
296(1)
Honors Certification™
297(1)
CMS-1500
298(10)
Item # and Item Name/Description
298(5)
Item 24B, Place of Service
303(2)
Tips on Completing the CMS-1500
305(1)
Summary
305(1)
Assignments
305(1)
Questions for Review
306(1)
Exercise 20 -- 1
307(1)
Honors Certification™
307(1)
UB-92 Hospital Billing Form
308(29)
Item# and Item Name/Description
308(5)
Item 4, Type of Bill
313(1)
Item 19, Type of Admission
314(1)
Item 20, Source of Admission
314(1)
Item 22, Patient Status
315(1)
Items 24-30, Condition Codes
315(3)
Items 32-35, Occurrence Codes
318(3)
Item 33, Occurrence Span Codes and Dates
321(1)
Items 39-41, Value Codes and Amounts
322(2)
Item 42, Hospital Revenue Codes
324(1)
Item 53, Assignment of Benefits
324(1)
Item 59, Relationship
325(1)
Item 64, Employment Status Code
325(1)
Summary
325(1)
Assignments
325(1)
Questions for Review
326(1)
Exercise 21 -- 1
327(2)
Honors Certification™
329(1)
Appendix 21 -- 1 Hospital Revenue Codes
330(7)
Hospital Billing
337(8)
Which Claim Form Is Right?
338(2)
Charge Description Masters
340(1)
Entering Charges
341(1)
How Billing Affects Other Departments
342(1)
Preauthorization, Pre-certifications and Utilization Reviews
342(1)
Ambulatory Surgical Centers
343(1)
Summary
343(1)
Assignments
343(1)
Questions for Review
344(1)
Honors Certification™
344(1)
Medical Reports
345(34)
Abstracting From Medical Records
345(1)
Triage Reports
345(1)
Operative Reports
346(1)
Diagnostic Testing Reports
346(1)
Medical History and Physical Examination Reports
346(1)
Summary
346(1)
Assignments
346(1)
Questions for Review
347(1)
Exercises 23 -- 1 through 23 -- 20
348(26)
Appendix 23 -- 1
374(4)
Honors Certification™
378(1)
Claims Submission Process
379(9)
Clean Claims
380(1)
Incomplete Data Master List
380(1)
Submission Time Limits
381(1)
Optical Scanning Guidelines
381(1)
Submitting the Claims
382(1)
Electronic Claims Submission
382(1)
Billing Reports
383(1)
Tracer Claims/Delinquent Claims
383(1)
Denied Claims
384(1)
Re-submissions
384(1)
Adjusted Claims
384(1)
Appeals
385(1)
Balance Billing Patients for Downcoded or Denied Claims
385(1)
State Insurance Commissioner
385(1)
Summary
385(1)
Assignments
386(1)
Questions for Review
386(1)
Honors Certification™
387(1)
Calculator Basics
388(7)
Key Descriptions
388(1)
Printer Tape Symbols
389(1)
Summary
390(1)
Assignments
390(1)
Questions for Review
390(1)
Exercises 25 -- 1 through 25 -- 4
391(3)
Honors Certification™
394(1)
General Office Procedures
395(9)
Mail
395(3)
Ordering Supplies
398(2)
Office Machines
400(1)
Tickler Files
401(1)
Summary
402(1)
Assignments
402(1)
Questions for Review
402(1)
Honors Certification™
403(1)
Customer Service/Patient Relations
404(22)
Understanding Needs
405(1)
Attitudes and Feelings
405(1)
First Impressions and Image
406(1)
Characteristics of Client Relations
406(1)
Customer Service Job Functions
406(1)
The Art of Listening
407(3)
Handling Difficult Clients
410(2)
Handling Unwanted Callers
412(1)
Professionalism
413(1)
Telephone Techniques
414(1)
Phone Calls
415(1)
Telephone Etiquette
416(1)
Maintaining an Appointment Calendar
417(2)
Summary
419(1)
Assignments
419(1)
Questions for Review
420(1)
Exercises 27 -- 1 through 27 -- 7
420(5)
Honors Certification™
425(1)
Computer Basics
426(10)
The Computer
427(1)
The Monitor
427(1)
The Keyboard
428(2)
Frustration Free Computing
430(2)
Computer Terms
432(2)
Summary
434(1)
Assignments
434(1)
Questions for Review
435(1)
Honors Certification™
435(1)
Correspondence for the Medical Office
436(13)
The Opening
437(1)
The Body
437(1)
The Closing
438(1)
Correspondence Containing Negative Content
438(1)
Format of the Letter
438(5)
Memos
443(2)
Postal Abbreviations
445(1)
Summary
446(1)
Assignments
446(1)
Questions for Review
446(1)
Exercises 29 -- 1 through 29 -- 2
447(1)
Honors Certification™
448(1)
Job Search Preparation
449
Job Search Objectives
449(1)
Uniqueness
449(1)
Target Audience
450(1)
Build Your Database
450(1)
The Resume
450(3)
The Cover Letter
453(1)
Marketing Yourself
453(1)
The Job Interview
453(3)
Getting Paid What You Are Worth
456(1)
Summary
457(1)
Assignments
457(1)
Questions for Review
458(1)
Exercise 30 -- 1
458(1)
Resume Questionnaire
459(2)
Honors Certification™
461(1)
Sample Resume # 1
462(1)
Sample Cover Letter # 1
463(1)
Sample Resume # 2
464(1)
Sample Resume # 3
465


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