Health Insurance Today : A Practical Approach

by Beik, Janet I.

• ISBN13: 9781416053200
• ISBN10: 1416053204
• Edition: 2nd
• Format: Paperback
• Copyright: 2008-10-16
• Publisher: Elsevier Science Health Science div

Summary

Learn to confidently complete and submit health insurance claims with this proven, practice-based approach! Realistic examples, case studies, and application exercises simplify the health insurance billing process and help you learn interactively. Instructional content is broken down into segments for easier learning, with a straightforward, conversational writing style that makes the material accessible and understandable. Accompanied by a companion CD with step-by-step claim form guidance, this easy-to-read resource is your key to mastering health insurance concepts and obtaining maximum reimbursement for your health care facility. An engaging, conversational writing style makes difficult concepts easier to grasp. Discussion questions and in-class activities presented throughout each chapter ease learning by breaking material into more manageable segments and reinforcing key points. Compliance tips alert you to important federal and state regulations. Real-world examples present complex concepts in a realistic, practice-based context similar to what you'll encounter on the job. Review and application exercises, including real-world case studies, critical thinking exercises, role-playing exercises, and collaborative learning activities, help you assess your knowledge and understand how to apply what you've learned to practice. Key term definitions and learning objectives streamline the learning process and familiarize you with important terminology and concepts. A companion CD reinforces your understanding and guides you interactively through the completion of insurance claims. An Evolve Resources website links you to additional information for further study and review. Updated claim form information familiarizes you with the current CMS-1500 (08-05) claim form for the most accurate billing and coding.

Table of Contents

Building a foundation

Medical Insurance: Where Did it Come From?

Tools of the Trade: A Career as a Health (Medical) Insurance Professional

The Legal & Ethical Side of Medical Insurance

Types and Sources of Health Insurance

Health insurance basics

The "Universal" Claim Form: CMS-1500

Traditional Fee-For-Service/Private Plans

Unraveling the Mysteries of Managed Care

Understanding Medicaid

Conquering Medicare's Challenges

Military Carriers - TRICARE/CHAMPVA

Miscellaneous Carriers: Worker's Compensation and Disability Insurance

Cracking the codes

Diagnostic Coding

Procedural, Evaluation & Management and HCPCS Coding

Claims process

The Patient

The Claim

Advanced application

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Claim Form: The UB-04

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