Karen Smiley is a certified, multi-specialty coding expert in physician and outpatient reimbursement with an extensive background in commercial, Medicare, and Medicaid claims processing. She is currently a professional coder at an ambulatory surgery center that specializes in orthopedic coding.
Introduction 1
Part I: Getting to Know Medical Billing and Coding 7
Chapter 1: Dipping Your Toes in Medical Billing and Coding 9
Chapter 2: Exploring the Billing and Coding Professions 19
Chapter 3: Weighing Your Employment Options 31
Part II: Boning Up on the Need-to-Knows of Your Profession 41
Chapter 4: Compliance: Understanding the Rules 43
Chapter 5: Not-So-Strange Bedfellows: Medical Terminology and Medical Necessity 57
Chapter 6: Getting to Know the Payers 79
Part III: Keys to Becoming a Professional: Getting Certified 95
Chapter 7: Your Basic Certifi cation Options, Courtesy of the AAPC and AHIMA 97
Chapter 8: The Path to Certifi cation: Finding a Study Program 111
Chapter 9: Signing Up and Preparing for the Certifi cation Exam 129
Chapter 10: Adding Street Cred: Specialty Certifi cations and Continuing Ed 147
Part IV: Dealing with the Nitty-Gritty On-the-Job Details 159
Chapter 11: Processing a Run-of-the-Mill Claim: An Overview161
Chapter 12: Honing In on How to Prepare an Error-free Claim 177
Chapter 13: From Clearinghouse to Accounts Receivable to Money in the Pocket 193
Chapter 14: Handling Disputes and Appeals 203
Chapter 15: Keeping Up with the Rest of the World223
Part V: Working with Stakeholders 235
Chapter 16: Dealing with Commercial Insurance Claims 237
Chapter 17: Caring about Medicare 249
Chapter 18: Client Relations and Coding Ethics: Being an Advocate for Your Employer 261
Part VI: The Part of Tens 277
Chapter 19: Ten Common Billing and Coding Mistakes and How to Avoid Them 279
Chapter 20: Ten Acronyms to Burn into Your Brain 283
Chapter 21: Ten Tips from Billing and Coding Pros 287
Glossary 293
Index 303
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