9780073374918

Medical Insurance: An Integrated Claims Process Approach

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  • ISBN13:

    9780073374918

  • ISBN10:

    0073374911

  • Edition: 5th
  • Format: Paperback
  • Copyright: 1/13/2011
  • Publisher: McGraw-Hill Education
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Summary

Medical Insurance 5e provides students with the knowledge and skills needed to successfully perform insurance and billing related duties. Following the medical billing process, instruction moves from a comprehensive introductory chapter through processing RA/EOBs and handling patient collections. It has extensive illustrations, forms, and exercises to develop required competencies. Exercises improve underlying essential math and communications skills. This text also provides a fundamental understanding of diagnostic and procedural coding needed to submit claims in compliance with payers' requirements.

Table of Contents

PART 1 WORKING WITH MEDICAL INSURANCE AND BILLING

CHAPTER 1 INTRODUCTION TO THE MEDICAL BILLING PROCESS

CHAPTER 2 HIPAA AND MEDICAL RECORDS

CHAPTER 3 PATIENT ENCOUNTERS AND BILLING INFORMATION

PART 2 CLAIM CODING

CHAPTER 4 DIAGNOSTIC CODING: INTRODUCTION TO ICD-9-CM

CHAPTER 5 PROCEDURAL CODING: INTRODUCTION TO CPT

CHAPTER 6 PROCEDURAL CODING: INTRODUCTION TO HCPCS

PART 3 CLAIM PREPARATION

CHAPTER 7 VISIT CHARGES AND COMPLIANT BILLING

CHAPTER 8 HEALTH CARE CLAIM PREPARATION AND TRANSMISSION

PART 4 PAYERS

CHAPTER 9 PRIVATE PAYERS/BLUE CROSS AND BLUE SHIELD

CHAPTER 10 MEDICARE

CHAPTER 11 MEDICAID

CHAPTER 12 TRICARE AND CHAMPVA

CHAPTER 13 WORKERS'COMPENSATION AND DISABILITY

PART 5 PAYMENT PROCESSING

CHAPTER 14 PAYMENTS (RAs/EOBs), APPEALS, AND SECONDARY CLAIMS

CHAPTER 15 PATIENT BILLING AND COLLECTIONS

PART 6 HOSPITAL SERVICES

CHAPTER 16 HOSPITAL BILLING AND REIMBURSEMENT

PART 7 CLAIM CASE STUDIES

CHAPTER 17 PRIMARY CLAIM CASES

CHAPTER 18 EOB/RA/SECONDARY CLAIM CASESGUIDE TO MEDISOFT

Appendix A Medical Billing and Coding Careers

Appendix B Place of Service Codes

Appendix C Medical Specialities and Taxonomy Codes

Appendix D Professional Web Sites

Appendix E Forms

Appendix F HIPAA FAQs

ABBREVIATIONS

GLOSSARY

INDEX

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