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Guide to Medical Billing and Coding : An Honors Certification Book,9780131722521
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Guide to Medical Billing and Coding : An Honors Certification Book

by
Edition:
2nd
ISBN13:

9780131722521

ISBN10:
0131722522
Format:
Paperback
Pub. Date:
4/7/2006
Publisher(s):
Prentice Hall
List Price: $85.33
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Summary

This comprehensive text includes not only insurance billing and claims, but also office procedures. It provides a complete understanding of all the skills necessary to perform as a medical biller, including a review of medical terminology.

Table of Contents

Medical Practice Administrationp. 1
Introduction to Medical Billing and Codingp. 3
Job Roles and Dutiesp. 4
The Medical Teamp. 4
Types of Healthcare Settingsp. 5
Basic Skill Requirements of the Medical Billerp. 6
Interpersonal Skillsp. 6
Stressp. 8
Prevacation Work Planningp. 9
Certification Programs for Medical Billersp. 10
Legal Issuesp. 10
Fraudp. 13
HIPAA and Fraud and Abusep. 14
Embezzlementp. 15
Employee Bonding and Errors and Omission Insurancep. 16
Claim Auditsp. 16
Medical Ethicsp. 16
Subpoenasp. 17
Instances in Which the Patient Should Be Notified and the File Notatedp. 19
Clinical Records and Medical Documentationp. 28
Medical Chartsp. 29
Filing the Chartp. 31
Medical Documentation Rulesp. 32
SOAP Notesp. 33
Signature Cardsp. 34
Retention of Recordsp. 34
Storing Medical Recordsp. 35
Electronic Medical Chartingp. 36
Computerized Filesp. 37
Record Transfersp. 38
Patient Information Sheetp. 39
Release of Information Formp. 42
Assignment of Benefits Formp. 46
Patient History Formp. 46
Insurance Verificationp. 46
Additional Suggestionsp. 49
Health Insurance Programsp. 55
Health Insurance Contract Interpretationp. 57
Blue Cross/Blue Shieldp. 58
Contract Provisionsp. 58
Contract Benefitsp. 63
Exclusionsp. 72
Allowed Amountsp. 72
Precertification of Inpatient Admissionsp. 73
Utilization Reviewp. 73
Second Surgical Opinion Consultationsp. 74
Coordination of Benefitsp. 75
Medicare and Medicaidp. 101
Medicarep. 102
Medicare Eligibilityp. 102
The Parts of Medicarep. 103
Allowable Chargesp. 104
Medicare Health Insurance Card (HIC)p. 105
Medicare Physician Identification Numbersp. 106
Medicare Billing Noticesp. 107
Assignment of Benefitsp. 112
Medicare Secondary Payerp. 115
Diagnosis-Related Group Billingp. 116
Durable Medical Equipmentp. 117
Medicare Denialsp. 117
Advance Beneficiary Notice (ABN)p. 117
The Medicare Appeals Processp. 120
Medicare Fraud and Abusep. 122
Medicare Supplemental Insurancep. 125
Medicare and Managed Carep. 125
Medicare Notice of Non-Coveragep. 125
Medicare Billing Guidelinesp. 126
Medicaidp. 126
Medicaid Covered Servicesp. 128
Reimbursement from Medicaidp. 129
Medicaid as Secondary Payerp. 130
Treatment Authorization Requestp. 130
Medicaid Billing Guidelinesp. 133
Workers' Compensationp. 140
Intent of the Workers' Compensation Systemp. 141
Employee Activitiesp. 142
Time Limitsp. 143
Fraud and Abusep. 143
Types of Workers' Compensation Benefitsp. 144
Treating Physiciansp. 146
Medical-Legal Evaluationsp. 146
Medical Service Orderp. 146
Patient Recordsp. 147
Doctor's First Report of Injury/Illnessp. 147
Progress Reportsp. 151
Physician's Final Reportp. 151
Billing for Workers' Compensation Servicesp. 152
Third-Party Liabilityp. 153
Liensp. 153
Delinquent Claimsp. 157
Delay of Adjudicationp. 157
Workers' Compensation Appealsp. 157
Reversalsp. 157
Managed Carep. 162
Rising Healthcare Costsp. 163
Managed Carep. 163
HMO Coveragep. 165
Preferred Provider Organizationsp. 165
Self-Insurancep. 167
Billing Managed Care Plansp. 167
Groups/IPAsp. 169
Capitation Paymentsp. 172
Appointment Schedulingp. 174
Authorizations, Referrals, and Second Opinionsp. 175
Denial of Services to Membersp. 177
Member Grievances and Complaintsp. 178
Transfersp. 179
Disenrollmentp. 179
Continuing Carep. 180
Miscellaneous Servicesp. 181
Sanctionsp. 182
Claim Paymentsp. 182
Finances and Accountingp. 193
Medical Practice Accountingp. 195
Patient Accountingp. 196
Accounts Payable/Receivablep. 196
Patient Ledger Card/Statement of Accountp. 196
Insurance Paymentsp. 198
Patient Paymentsp. 200
Posting Paymentsp. 200
Balance Billingp. 200
Follow-Upsp. 201
Collectionsp. 202
Collections Proceduresp. 204
Small Claims Courtp. 207
Practice Accountingp. 208
Petty Cashp. 208
The Day Sheet/Daily Journalp. 209
Office Reportsp. 211
Medical Codingp. 219
Reference Booksp. 221
ICD-9-CMp. 222
CPTp. 222
Medical Dictionaryp. 222
Merck Manualp. 223
Physicians' Desk Referencep. 223
HCPCSp. 226
International Classification of Disease (ICD-9-CM) Codingp. 245
History of the ICD-9-CMp. 246
Contents of the ICD-9-CMp. 246
How to Use the ICD-9-CMp. 246
General Guidelinesp. 247
Main Termsp. 248
Exceptionsp. 249
V Codesp. 252
E Codesp. 253
Signs and Symbols Used in the ICD-9-CMp. 253
ICD-10-CMp. 254
Current Procedural Terminology (CPT) Codingp. 266
Using the CPTp. 267
Semicolons in the CPTp. 267
Signs and Symbols Used in the CPTp. 268
Using the CPT Indexp. 268
Modifiersp. 268
Unlisted Codesp. 268
Evaluation and Management Codesp. 268
Anesthesiap. 271
Surgeryp. 275
Radiology/X-rayp. 280
Pathology/Laboratoryp. 281
Medicinep. 282
Medical Billingp. 299
The CMS-1500 Form and Medical Billing Proceduresp. 301
Superbillp. 302
CMS-1500 Block Explanationsp. 306
1500 Health Insurance Claim Form (Version 08/05)p. 308
Patient Claim Formp. 310
Billing for Servicesp. 311
Incomplete Data Master Listp. 314
Determining the Proper Billing Amountp. 315
Special Servicesp. 316
Claims Submission Processp. 316
Clean Claimsp. 318
Coordination of Benefitsp. 318
COB with Health Maintenance Organizationsp. 319
Collecting the Patient Portionp. 320
Tricarep. 321
Billing Reportsp. 323
Prompt Payment Lawsp. 323
Tracer Claims/Delinquent Claimsp. 325
Denied Claimsp. 325
Resubmission of Claimsp. 325
Adjusted Claimsp. 325
Review and Appealsp. 326
Balance Billing Patients for Downcoded or Denied Claimsp. 326
State Insurance Commissionerp. 326
Maximum Reimbursement Guidelinesp. 327
The UB-92 Form and Hospital Billing Proceduresp. 333
Field Locator # and Name/Descriptionp. 335
Uniform Bill (UB-04)p. 339
Item 42, Hospital Revenue Codesp. 339
Item 53, Assignment of Benefitsp. 342
Chargemaster Descriptionsp. 345
Entering Chargesp. 346
How Billing Affects Other Departmentsp. 347
Preauthorization, Precertifications, and Utilization Reviewsp. 347
Ambulatory Surgical Centersp. 348
Abstracting, Billing, and Coding from Medical Reportsp. 357
Abstracting from Medical Recordsp. 358
Triage Reportsp. 358
Operative Reportsp. 358
Diagnostic Testing Reportsp. 358
Medical History and Physical Examination Reportsp. 358
General Office Proceduresp. 389
Basic Office Functions and Communicationsp. 391
Mailp. 392
Office Machinesp. 396
Tickler Filesp. 397
Practice Communicationp. 398
The Openingp. 399
The Bodyp. 399
The Closingp. 399
Correspondence Containing Negative Contentp. 399
Format of the Letterp. 400
Memosp. 400
Patient Relationsp. 405
First Impressions and Imagep. 406
Customer Service Job Functionsp. 406
The Art of Listeningp. 407
Maintaining an Appointment Calendarp. 411
Securing Employmentp. 421
Job Search Preparationp. 423
Key Descriptionsp. 424
Printer Tape Symbolsp. 425
Computer Basicsp. 425
The Computerp. 425
The Monitorp. 427
The Keyboardp. 428
Computer Termsp. 430
Job Search Preparationp. 433
Job Search Objectivesp. 433
Uniquenessp. 433
Target Audiencep. 433
Build Your Databasep. 434
The Resumep. 434
The Cover Letterp. 436
Marketing Yourselfp. 437
The Job Interviewp. 438
Getting Paid What You Are Worthp. 440
Appendicesp. 457
Provider and Medical Abbreviationsp. 459
Provider Abbreviationsp. 460
Medical Abbreviationsp. 461
Formsp. 464
Patient Information Sheetp. 465
Insurance Coverage Formp. 467
Doctor's First Report of Occupational Injury or Illnessp. 468
Lien Letterp. 469
Lien Formp. 470
Insurance Tracerp. 471
Encounter Formp. 472
Patient Receiptp. 473
Ledger Card/Statement of Accountp. 474
Day Sheet/Daily Journalp. 475
Deposit Slip/Ticketp. 476
Patient Claim Formp. 477
Superbill/Charge Slipp. 479
Insurance Claim Registerp. 480
CMS-1500 Claim Formp. 481
UB-92 Billing Formp. 482
Hospital Admission Formp. 483
Domestic Return Receiptp. 484
Certified Mail Formp. 485
Ground Tracking ID COD Prepaidp. 486
COD Airbillp. 487
COD Shipper Receiptp. 488
Ground Tracking ID Prepaidp. 488
Airbillp. 489
Stationeryp. 490
Envelopep. 491
Tablesp. 492
Patient Data Tablep. 493
Provider Data Tablep. 494
Order of Benefit Determinationp. 495
Medicare Secondary Payerp. 496
Quick Reference Codesp. 497
Place of Service Codesp. 501
Hospital Revenue Codesp. 504
Hospital Form Locator Codesp. 516
State Abbreviationsp. 521
Other Address Abbreviationsp. 522
CMS-1500/1500 Health Insurance Claim Formp. 523
CMS-1500 Claim Form Matrixp. 524
CMS-1500 Sample Claimsp. 543
1500 Health Insurance Claim Formp. 548
UB-92 (CMS-1450)/UB-04p. 550
UB-92 Form Matrixp. 551
UB-92 Sample Claimsp. 576
UB-92 to UB-04 Crosswalkp. 581
Glossaryp. 586
Creditsp. 595
Indexp. 597
Table of Contents provided by Ingram. All Rights Reserved.


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