COMPREHENSIVE HEALTH INSURANCE: BILLING, CODING & REIMBURSEMENT, 2/eprovides students with the knowledge and skills needed to work in a variety of medical billing and coding positions in the medical field. Comprehensive in approach, it covers the foundations of insurance, billing, coding and reimbursement. Students learn not only the submission of claims to the insurance carrier, but also reviewing medical records, verifying patient benefits, submitting a secondary claim, posting payments and appealing the insurance carrier's decision. This edition includes new chapters devoted to HIPAA and ICD-10-CM Medical Coding, as well as outstanding coverage of electronic records. Numerous case studies and patient files are included throughout and demonstrate refunds and appeals, auditing and compliance, Medicare calculations and professionalism.

SECTION I: A CAREER IN HEALTH CARE

1.    Introduction to Professional Billing and Coding Careers

 

 SECTION II: THE RELATIONSHIP BETWEEN THE PATIENT, PROVIDER, AND CARRIER

2.    Understanding Managed Care: Insurance Plans

3.    Understanding Managed Care: Medical Contracts and Ethics

4.    HIPAA: Health Insurance Portability and Accountability Act of 1996 

 

SECTION III: MEDICAL CODING

5.    ICD-9-CM Medical Coding

6.    ICD-10-CM Medical Coding

7.    Introduction to CPT and Place of Service Coding

8.    Coding Procedures and Services

9.    HCPCS and Coding Compliance

10.  Auditing

 

 SECTION IV: MEDICAL CLAIMS

11.  Physician Medical Billing

12.  Hospital Medical Billing 

 

SECTION V: GOVERNMENT MEDICAL BILLING

13.  Medicare Medical Billing

14.  Medicaid Medical Billing

15.  TRICARE Medical Billing 

 

SECTION VI: ACCOUNTS RECEIVABLE

16.  Explanation of Benefits and Payment Adjudication

17.  Refunds and Appeals

 

SECTION VII: INJURED EMPLO YEE MEDICAL CLAIM

18.  Workers' Compensation

 

SECTION VIII: USE OF MEDICAL PRACTICE MANAGEMENT SOFTWARE

19.  Electronic Medical Claims Processing