Introduction | p. 1 |
Coding Systems | p. 1 |
Claims Forms | p. 3 |
Establishing Provider Charges | p. 3 |
Contents and Format of This Guide | p. 4 |
The Reimbursement Process | p. 7 |
Payer Comparisons | p. 7 |
Government Health Plans | p. 9 |
Payment Methodologies | p. 11 |
Calculating Costs | p. 13 |
Other Factors Influencing Payment | p. 14 |
Participation in Medicare Plans | p. 25 |
Supplemental Medicare Coverage | p. 27 |
Workers' Compensation | p. 32 |
Documentation--An Overview | p. 33 |
Methods of Documentation | p. 34 |
General Guidelines for Documentation | p. 34 |
Principles of Documentation | p. 35 |
Fraud and Abuse | p. 37 |
Compliance | p. 41 |
Action Plan | p. 42 |
Claims Processing | p. 43 |
What to Include in Claims | p. 43 |
HIPAA | p. 44 |
Processing the Claim | p. 48 |
Collection Policies | p. 50 |
Appeals Process | p. 51 |
Medicare Benefit Notices | p. 55 |
HCFA-1500: Purpose and Instructions | p. 60 |
UB-92: Purpose and Instructions | p. 80 |
CPT Definitions and Guidelines | p. 87 |
Structure of CPT | p. 87 |
CPT Coding Conventions | p. 87 |
Surgical Services and Procedures | p. 92 |
Radiology | p. 208 |
Laboartory and Pathology | p. 231 |
Medicine Services | p. 255 |
Evaluation and Management Services | p. 263 |
CPT Index | p. 303 |
ICD-9-CM Definitions and Guidelines | p. 313 |
Structure of ICD-9-CM | p. 313 |
ICD-9-CM Index | p. 361 |
HCPCS Level II Definitions and Guidelines | p. 445 |
Level II National Codes | p. 445 |
Level III Local Codes | p. 445 |
Structure and Use of HCPCS Level II Codes | p. 446 |
The Conventions: Symbols and Modifiers | p. 448 |
Modifiers | p. 449 |
HCPCS Level II Codes | p. 452 |
HCPCS Level II Index | p. 493 |
Medicare Official Regulatory Information--CIM/MCM References | p. 497 |
Glossary | p. 603 |
Category III Codes | p. 617 |
Correct Coding Initiative | p. 621 |
Index | p. 671 |
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