Comprehensive Health Insurance Billing, Coding and Reimbursement

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  • Edition: 1st
  • Format: Paperback
  • Copyright: 2008-02-25
  • Publisher: Pearson
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This book was written to provide trainees with the knowledge and skills necessary to work in a variety of medical billing and coding positions in the medical field. Easy to read and comprehend, it is designed for professionals who have not previously worked in the medical field as well as professionals who have worked in the field but have only been exposed to certain aspects of the billing process. In order to adapt to the growing number of facilities that are becoming more automated, this book not only reviews non-automated procedures but it also gives in-depth content on automated procedures. A few exciting features to this book are: Case Studieswith Critical Thinking Questions; a key terms listappears at the beginning of each chapter;Professional Tipsappear throughout the text and provide additional information related to billing and coding processes; and any material within the text that is related to HIPAA is flagged with an icon so that students can identify the "need to know" law.

Author Biography

Deborah Vines has worked extensively for over 20 years in the healthcare industry as a Practice Administrator and Manager in physical therapy, dermatopathology and pediatrics.  She has also held management positions in the hospital setting.  As Director of Operations for a national healthcare staffing corporation, she has traveled across the United States, working directly with physicians and medical human resources to secure jobs for individuals in the medical billing, coding and collection fields.  A mentionable achievement of Ms. Vines’ is in one fiscal year she assisted 300 recruits find employment in this industry through mentoring and training. This achievement led her to open a successful vocational school specializing in medical office specialist training.


Ann B. Braceland has been working in the medical field since graduation from Gwynedd Mercy College is 1964 with an associate's degree in nursing. As a practice manager she has demonstrated the ability to adopt to changes to the challenges that arise in medical billing, coding and managed care contracts. Mrs. Braceland has established and managed offices in Physical Medicine and Occupational Medicine. These experiences led her to teaching skills. She is now highly regarded for training physicians and medical personnel in compliance coding, billing as well as medical office management. She was a Medicare representative and Director of Training of Allied Career School in Dallas, TX. Her teaching and lectures has formed the basis of this subsequent text.


Elizabeth Rollins, NCICS began her career in a nationally renowned multi-office pediatric ophthalmology practice. She worked in every position, from medical receptionist and appointment scheduling, to medical records and insurance claims submission, before being promoted to Insurance/Collection Manager. She completed insurance claims by hand and typed the patient billing statements for four years until the practice became computerized. As a Certified Account Manager for a national healthcare staffing corporation, Elizabeth met with hospitals, physicians, clinics and CBOs to assess their employment needs and showcase her roster of employees ready for hire. Elizabeth is a National Certified Insurance and Coding Specialist as well as the Director and an Instructor at a vocational school where she enjoys meeting with, teaching and encouraging students on a daily basis.


Susan Miller, NCICS has 20 years experience in the medical field and currently specializes in dialysis billing.  She was previously a Lead Instructor at a vocational school, preparing students for a career in the medical field as medical office specialists.  She has acted as a supervisor at insurance companies and worked one-on-one with policyholders to assist them in having a better understanding of health insurance.  In 2004 she obtained the title of National Certified Insurance & Coding Specialist.  She also holds certificates from Career Colleges and schools of Texas and Brookhaven College for Interactive Leadership Skills for Educators.

Table of Contents

A Career in Healthcare
Introduction to Professional Billing and Coding Careers
Employment Demand
Facilities Physician Practice
Centralized Billing Office
Job Descriptions
Medical Office Assistant
Medical Biller
Medical Coder
Registered Health Information Technicians (RHIT)
Payment Poster
Medical Collector
Refund Specialist
Insurance Verification Representative
Admitting Clerk or Front Desk Representative
Patient Information Clerk
Professional Memberships
Medical Office Assistant Certification
Medical Billing Certifications
Medical Coding Certifications
Medical Records Certification
Relationship between the Patient, Provider and Carrier
Managed Care Terminology
The History of Healthcare in America
Medical Reform
Definition of Managed Health Care
Managing and Controlling Cost
Discounted Fees
Patient Care Delivered Is Medically Necessary
Care Rendered By Appropriate Provider
Appropriate Medical Care in Least Restrictive Setting
Withholding Providersrsquo; Funds
Insurance Plans
Table of Contents provided by Publisher. All Rights Reserved.

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