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Workbook to Accompany Understanding Health Insurance : A Guide to Billing and Reimbursement,9781401896096

Workbook to Accompany Understanding Health Insurance : A Guide to Billing and Reimbursement

by ;
Edition:
8th
ISBN13:

9781401896096

ISBN10:
140189609X
Format:
Paperback
Pub. Date:
9/9/2005
Publisher(s):
CENGAGE Delmar Learning
List Price: $54.00

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Questions About This Book?

What version or edition is this?
This is the 8th edition with a publication date of 9/9/2005.
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

The restructured chapter content of the workbook offers application-based assignments with more critical thinking components. The assignments require learners to demonstrate an understanding of the content rather than simple recall of facts. Chapter 1 provides guidelines for professional development as well as initiating a job search, with numerous resources identified. Chapters 2-17 offer an in-depth review of health insurance billing and reimbursement concepts.

Table of Contents

Introduction vii
Health Insurance Specialist Career
1(20)
Assignment 1.1 Interview of a Professional
1(1)
Assignment 1.2 Ready, Set, Get a Job!
2(14)
Assignment 1.3 Journal Abstract
16(1)
Assignment 1.4 Professional Discussion Forums (Listservs)
17(1)
Assignment 1.5 Multiple Choice Review
18(3)
Introduction to Health Insurance
21(12)
Assignment 2.1 Health Insurance Coverage Statistics
21(4)
Assignment 2.2 Major Developments in Health Insurance (Research Paper)
25(5)
Assignment 2.3 Multiple Choice Review
30(3)
Managed Health Care
33(6)
Assignment 3.1 National Committee for Quality Assurance (NCQA) Health Plan Report Card
33(1)
Assignment 3.2 Managed Health Care Federal Legislation
34(1)
Assignment 3.3 Multiple Choice Review
35(4)
Life Cycle of an Insurance Claim
39(14)
Assignment 4.1 Payment of Claims: Encounter Form
39(2)
Assignment 4.2 Payment of Claims: Remittance Advice
41(8)
Assignment 4.3 Payment of Claims: Explanation of Benefits
49(1)
Assignment 4.4 Multiple Choice Review
50(3)
Legal and Regulatory Issues
53(8)
Assignment 5.1 HIPAA: Student Confidentiality Statement
53(1)
Assignment 5.2 HIPAA: Preventing Health Care Fraud and Abuse
54(2)
Assignment 5.3 HIPAA: Privacy and Security Rules
56(1)
Assignment 5.4 Multiple Choice Review
56(5)
ICD-9-CM Coding
61(12)
Assignment 6.1 ICD-9-CM Index to Diseases
61(1)
Assignment 6.2 Basic Coding
62(1)
Assignment 6.3 Multiple Coding
62(1)
Assignment 6.4 Combination Coding
63(1)
Assignment 6.5 Coding Hypertension
63(1)
Assignment 6.6 Coding Neoplasms
64(1)
Assignment 6.7 Assigning V Codes (Factors Influencing Health Status and Contact with Health Services)
64(1)
Assignment 6.8 Coding Burns, Fractures, and Late Effects
65(1)
Assignment 6.9 Assigning E Codes (External Causes of Injury and Poisoning)
66(1)
Assignment 6.10 Coding Procedures
66(1)
Assignment 6.11 Coding Patient Cases
67(2)
Assignment 6.12 Multiple Choice Review
69(4)
CPT Coding
73(12)
Assignment 7.1 CPT Index
73(1)
Assignment 7.2 Evaluation and Management (E/M) Coding
74(1)
Assignment 7.3 Anesthesia Coding
74(1)
Assignment 7.4 Surgery Coding
75(2)
Assignment 7.5 Radiology Coding
77(1)
Assignment 7.6 Pathology and Laboratory Coding
77(1)
Assignment 7.7 Medicine Coding
78(1)
Assignment 7.8 Assigning CPT Modifiers
78(1)
Assignment 7.9 Coding Case Studies
79(3)
Assignment 7.10 Multiple Choice Review
82(3)
HCPCS Coding
85(12)
Assignment 8.1 HCPCS Index
85(1)
Assignment 8.2 HCPCS Coding
86(5)
Assignment 8.3 Coding Drugs in HCPCS
91(1)
Assignment 8.4 HCPCS Level II National Modifiers
91(1)
Assignment 8.5 Coding Case Studies
92(2)
Assignment 8.6 Multiple Choice Review
94(3)
CMS Reimbursement Methodologies
97(8)
Assignment 9.1 Outpatient Prospective Payment System (OPPS)
97(1)
Assignment 9.2 Diagnosis Related Groups
98(3)
Assignment 9.3 Multiple Choice Review
101(4)
Coding for Medical Necessity
105(12)
Assignment 10.1 Choosing the First-Listed Diagnosis
105(1)
Assignment 10.2 Linking Diagnoses with Procedures/Services
106(1)
Assignment 10.3 National Coverage Determinations
106(1)
Assignment 10.4 Coding from Case Scenarios
107(1)
Assignment 10.5 Coding from SOAP Notes and Operative Reports
108(4)
Assignment 10.6 Multiple Choice Review
112(5)
Essential CMS-1500 Claim Instructions
117(8)
Assignment 11.1 Optical Scanning Guidelines
117(1)
Assignment 11.2 Entering Diagnoses and Procedures on the CMS-1500 Claim Form
117(4)
Assignment 11.3 Multiple Choice Review
121(4)
Commercial Insurance
125(14)
Assignment 12.1 Commercial Primary CMS-1500 Claims Completion
125(1)
Assignment 12.2 Commercial Secondary CMS-1500 Claims Completion
125(6)
Assignment 12.3 Multiple Choice Review
131(8)
Blue Cross and Blue Shield Plans
139(12)
Assignment 13.1 BCBS Primary CMS-1500 Claims Completion
139(1)
Assignment 13.2 BCBS Secondary CMS-1500 Claims Completion
139(9)
Assignment 13.3 Multiple Choice Review
148(3)
Medicare
151(18)
Assignment 14.1 Medicare Primary CMS-1500 Claims Completion
151(1)
Assignment 14.2 Medicare as Secondary Payer CMS-1500 Claims Completion
151(8)
Assignment 14.3 Medicare/Medigap CMS-1500 Claims Completion
159(1)
Assignment 14.4 Medicare/Medicaid CMS-1500 Claims Completion
159(1)
Assignment 14.5 Multiple Choice Review
159(10)
Medicaid
169(10)
Assignment 15.1 Medicaid Primary CMS-1500 Claims Completion
169(1)
Assignment 15.2 Medicaid Mother/Baby CMS-1500 Claims Completion
169(7)
Assignment 15.3 Multiple Choice Review
176(3)
Tricare
179(8)
Assignment 16.1 Tricare Primary CMS-1500 Claims Completion
179(1)
Assignment 16.2 Multiple Choice Review
179(8)
Workers' Compensation
187(70)
Assignment 17.1 Workers' Compensation Primary CMS-1500 Claims Completion
187(1)
Assignment 17.2 Multiple Choice Review
187(70)
InstaClaim Trial Version CD-ROM 257


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