Insurance Handbook for the Medical Office

by Fordney, Marilyn Takahashi

• ISBN13: 9781416036661
• ISBN10: 1416036660
• Edition: 10th
• Format: Paperback
• Copyright: 2007-11-07
• Publisher: Elsevier Science Health Science div

Summary

Trusted by medical insurance specialists for more than 30 years, Insurance Handbook for the Medical Office helps you excel at all aspects of insurance billing for a full range of today's health care plans. This edition helps you keep pace with industry changes, featuring the latest information on HIPAA regulations, diagnostic coding, procedural coding, office and insurance collection strategies, Medicare, and more. The accompanying Student Workbook with CD-ROM (sold separately) lets you practice "real world" billing with patient simulations using Altapoint and the Student Software Challenge. Procedural (CPT and HCPCS) and diagnostic (ICD-9-CM) coding and documentation are emphasized, since they are the keystones to obtaining maximum reimbursement. Key terms are bolded at first mention, explained within the context of the discussion, and defined in the glossary. Separate chapters on Electronic Data Interchange and HIPAA Compliance and Privacy in Insurance Billing provide essential knowledge of electronic claims filing, informing you of submission guidelines used in the majority of medical offices today. Icons clearly identify each insurance payer with a specific color and graphic, making specific information easy to locate. Compliance features located at appropriate points throughout most chapters offer tips to ensure compliance with correct billing and coding practice, particularly HIPAA and OIG. A separate chapter on documentation in the medical office describes how proper documentation can prevent penalties and refund requests, and help you prove compliance in the case of an audit or review. Detailed examples and samples of completed insurance forms show you how to apply knowledge in the real world. Emphasis on the business of running a medical office highlights the importance of the medical insurance specialist's role in filing clean claims, solving problems that do occur, and collecting overdue payments. Service to Patient feature throughout the chapters focuses on ways to provide quality service to the patient as well as your co-workers. All content has been reviewed by industry experts and meticulously updated to reflect recent changes in insurance claim filing. In addition to the list of key terms at the beginning of each chapter, a separate list of key abbreviations clarifies common terms identified in the field primarily by their abbreviations. Key points at the end of each chapter briefly summarize important chapter content to help you better understand the subject matter.

Table of Contents

Career Role and Responsibilities

Role of an Insurance Billing Specialist

Hipaa Compliance and Privacy in Insurance Billing

The Claims Process

Basics of Health Insurance

Medical Documentation

Diagnostic Coding

Procedural Coding

The Paper Claim: CMS-1500

Electronic Data Interchange: Transactions and Security

Receiving Payments and Insurance Problem Solving

Office and Insurance Collection Strategies

Health Care Payers

The Blues Plans, Private Insurance, and Managed Care Plans

Medicare

Medicaid and Other State Programs

Tricare and Champva

Workers Compensation

Disability Income Insurance and Disability Benefit Programs

Inpatient and Outpatient Billing

Hospital Billing

Seeking a Job and Attaining Professional Advancement

Table of Contents provided by Publisher. All Rights Reserved.