From Patient to Payment : Insurance Procedures for the Medical Office, Student Text with Data Disk

by Newby, Cynthia

• ISBN13: 9780078252532
• ISBN10: 0078252539
• Edition: 3rd
• Format: Paperback
• Copyright: 2001-10-17
• Publisher: MCG

Summary

This concise, practical text-workbook provides extensive real-world practice with the universal medical insurance claim form, the HCFA 1500. Includes flow charts, claims processing forms, and medical reports. Coding and billing content is based on industry practice and addresses electronic claims and a variety of compliance issues. The text provides a brief introduction to MediSoft Advanced Patient Billing Software.

Table of Contents

Preface	viii
Acknowledgments	x
From Patient to Payment	2	(14)
Introduction to Medical Insurance	4	(1)
Common Types of Medical Insurance	5	(1)
The Insurance Claim Process	6	(5)
Professional Focus: The Internet and Medical Insurance	11	(1)
The Responsibilities of a Medical Insurance Specialist	11	(1)
Effects of Insurance Claim Errors	12	(4)
Legal Considerations	16	(10)
Confidentiality of Medical Records	18	(1)
Medicolegal Information	18	(4)
Medicolegal Records: Retention and Documentation	22	(1)
Avoiding Fraud	23	(3)
Professional Focus: Compliance Plans	24	(2)
Diagnostic Coding	26	(20)
Introduction to Diagnostic Coding	28	(1)
Coding Basics for Physician Practices	29	(3)
Professional Focus: The Encounter Form	31	(1)
Using the ICD	32	(4)
Five Steps to Diagnostic Coding	36	(6)
Preview of ICD-10-CM	42	(4)
Procedural Coding	46	(16)
Introduction to Procedure Codes in the CPT	48	(2)
Coding Evaluation and Management Services	50	(2)
Professional Focus: Certification as a Medical Coder	52	(1)
Coding Surgical Procedures	52	(1)
Coding Laboratory Procedures	53	(1)
Coding Immunizations	53	(1)
HCPCS Codes	53	(1)
Five Steps for Locating Correct CPT Codes	54	(5)
Preview of CPT 5	59	(3)
The HCFA-1500 Form	62	(34)
Introduction to the HCFA-1500 Claim Form	64	(4)
Professional Focus: Administrative Simplification	68	(1)
Patient and Insured Information	68	(9)
Physician or Supplier Information	77	(10)
Claim Completion	87	(9)
Electronic Claims	96	(12)
Using Computers to Process Claims	98	(1)
Electronic Claims and Paper Claims: Advantages and Disadvantages	98	(2)
Professional Focus: Career Opportunities in Medical Office Settings	100	(1)
Transmission Methods for Electronic Claims	100	(2)
Optical Character Recognition	102	(1)
Security Concerns Associated with Electronic Transmission	103	(1)
Electronic Transaction Standards	104	(1)
Steps in the Submission Process	104	(4)
Reimbursement: Managed Care and Indemnity Plans	108	(14)
The Reimbursement Process	110	(2)
Types of Managed Care Plans	112	(2)
Professional Focus: Career Opportunities with Insurance Companies	114	(1)
Methods of Setting Allowed Charges	114	(1)
The Electronic Remittance Advice/Explanation of Benefits	115	(3)
Processing Reimbursement Information	118	(4)
Blue Cross and Blue Shield	122	(8)
Introduction to Blue Cross and Blue Shield	124	(1)
Federal Employee Health Benefits Plan	124	(1)
Key Features of Blue Cross and Blue Shield Plans	125	(1)
Physician Participation and Reimbursement	125	(1)
Filing Claims for Special Cases and National Groups	126	(1)
Membership Card Information	126	(1)
Filing Deadlines	127	(3)
Professional Focus: Blue Cross/Blue Shield	128	(2)
Medicaid	130	(8)
Introduction to Medicaid	132	(1)
Medicaid Coverage	132	(2)
Professional Focus: Managed Care and Medicaid	133	(1)
Medicaid Eligibility	134	(1)
Filing Medicaid Claims	134	(4)
Medicare	138	(12)
Medicare Overview	140	(3)
Filing Medicare Claims	143	(2)
Professional Focus: Medicare's Correct Coding Initiative	144	(1)
Who Pays First?	145	(5)
Tricare and Champva	150	(10)
Tricare	152	(1)
Champva	153	(1)
Professional Focus: Privacy Rules	154	(1)
Beneficiary Identification	154	(1)
Billing Beneficiaries	155	(1)
Primary or Secondary Payer?	156	(4)
Workers' Compensation	160	(8)
When Employees Are Hurt at Work	162	(1)
Federal Programs, Forms, and Procedures	162	(1)
Professional Focus: Workers' Compensation Terminology	163	(1)
State Programs, Forms, and Procedures	163	(2)
Keeping Separate Records	165	(3)
Disability	168	(8)
Replacing Lost Income	170	(1)
Filing for Disability Benefits	171	(5)
Professional Focus: Consulting and Educational Career Opportunities	173	(3)
Dental Insurance	176	(14)
Introduction to Dental Terms	178	(3)
Dental Insurance	181	(1)
Professional Focus: Dental Injury Claims and Workers' Compensation	182	(1)
Processing Dental Claims	182	(8)
Hospital Insurance	190	(12)
Health Care Facilities: Inpatient Versus Outpatient	192	(1)
Hospital Claims Processing	193	(2)
Inpatient (Hospital) Coding	195	(1)
Payers and Payment Methods	196	(1)
Claims and Follow up	197	(5)
Professional Focus: Career Opportunities in Hospitals	199	(3)
Reimbursement Follow-Up and Collections	202	(12)
Delinquent Payments From Carriers	204	(1)
Denied or Delayed Payments From Carriers	205	(1)
Claim Rejection Appeals and Audits	206	(2)
Patient Billing and Collections	208	(6)
Professional Focus: Career Opportunities in Collections	209	(5)
Computers and the Billing Cycle	214	(18)
Introduction to Computerized Medical Office Systems	216	(1)
Patient Billing Programs	216	(1)
The Computerized Billing Cycle	217	(5)
Professional Focus: National Electronic Transaction Standards	221	(1)
Data Entry in MediSoft	222	(10)
HCFA Form Simulations	232	(20)
Manual Simulations	234	(5)
Computerized Simulations	239	(13)
Glossary	252	(13)
Index	265	(12)
Blank HCFA Forms	277