Download Understanding Health Insurance: A Guide to Billing and Reimbursement - 2021 Edition, 16th Edition PDF ebook, Michelle Green, Cengage Learning (9780357515709, 9780357515709)
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Develop the skills and background you need for a career in medical billing and insurance processing or revenue management with Green’s UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2021 Edition. This complete resource explains the latest medical code sets and guidelines as you learn how to a-sign ICD-10-CM, CPT and HCPCS level II codes; complete health care claims and master revenue management concepts. You focus on today’s most important topics, including managed care, legal and regulatory issues, coding systems and compliance, reimbursement methods, clinical documentation improvement, coding for medical necessity and common health insurance plans. Updated every year, this edition address changes to ICD-10-CM and CPT 2021 codes and introduces you to important developments, such as electronic claims processing, clinical quality language (CQL) and changes to the requirements for the National Healthcare A-sociation (NHA) Certified Billing and Coding Specialist.Important Notice: Media content referenced within the product description or the product text may not be available in the ebook version.
Table of ContentsPrefaceAbout the AuthorReviewersAcknowledgmentsHow To Use This TextSimclaim CMS-1500 Software User GuideChapter 1: Health Insurance Specialist CareerHealth Insurance OverviewCareer OpportunitiesEducation and TrainingJob ResponsibilitiesIndependent Contractor and Employer LiabilityProfessionalismProfessional A-sociations and CredentialsSummaryInternet LinksReviewChapter 2: Introduction to Health InsuranceIntroduction to Health InsuranceMajor Developments in Health InsuranceHealth Care DocumentationElectronic Health Record (EHR)SummaryInternet LinksReviewChapter 3: Managed Health CareHistory of Managed CareManaged CareManaged Care ModelsConsumer-Directed Health PlansAccreditation of Managed Care OrganizationsEffects of Managed Care on a Physician’s PracticeSummaryInternet LinksReviewChapter 4: Revenue Cycle ManagementRevenue Cycle ManagementEncounter Form and ChargemasterProcessing an Insurance ClaimManaging PatientsManaging Office Insurance FinancesInsurance Claim CycleMaintaining Insurance Claim FilesCredit and CollectionsSummaryInternet LinksReviewChapter 5: Legal Aspects of Health Insurance and ReimbursementOverview of Laws and RegulationsFederal Laws and Events That Affect Health CareRetention of RecordsHealth Care Audit and Compliance ProgramsHealth Insurance Portability and Accountability Act (HIPAA)SummaryInternet LinksReviewChapter 6: ICD-10-CM CodingGeneral Equivalence MappingsOverview of ICD-10-CM and ICD-10-PCSICD-10-CM Coding ConventionsICD-10-CM Index and Tabular ListOfficial Guidelines for Coding and ReportingSummaryInternet LinksReviewChapter 7: CPT CodingOrganization of CPTCPT IndexCPT ModifiersEvaluation and Management SectionAnesthesia SectionSurgery SectionRadiology SectionPathology and Laboratory SectionMedicine SectionCPT Category II and Category III CodesSummaryInternet LinksReviewChapter 8: HCPCS Level II CodingPurpose of HCPCS Level II CodesOrganization of HCPCS Level II CodesDocumentation and Submission Requirements for Reporting HCPCS Level II CodesAssigning HCPCS Level II Codes and ModifiersSummaryInternet LinksReviewChapter 9: CMS Reimbursement MethodologiesCMS ReimbursementCMS Fee SchedulesCMS Payment SystemsSummaryInternet LinksReviewChapter 10: Coding Compliance Programs,Clinical DocumentationImprovement, and Coding forMedical NeceCoding Compliance ProgramsClinical Documentation ImprovementCoding for Medical NecessityCoding from Case Scenarios and Patient RecordsSummaryInternet LinksReviewChapter 11: CMS-1500 and UB-04 ClaimsGeneral Claims InformationCMS-1500 Data EntryProcessing Secondary CMS-1500 ClaimsCommon Errors that Delay CMS-1500 Claims ProcessingFinal Steps in Processing CMS-1500 ClaimsMaintaining CMS-1500 Insurance Claim Files for the Medical PracticeUB-04 ClaimSummaryInternet LinksReviewChapter 12: Commercial InsuranceCommercial Health InsuranceAutomobile, Disability, and Liability InsuranceCommercial Claims InstructionsCommercial Secondary Coverage Claims InstructionsCommercial Group Health Plan Coverage Claims InstructionsSummaryInternet LinksReviewChapter 13: BlueCross BlueShieldBlueCross BlueShieldBlueCross BlueShield PlansBlueCross BlueShield Billing NotesBlueCross BlueShield Claims InstructionsBlueCross BlueShield Secondary Coverage Claims InstructionsSummaryInternet LinksReviewChapter 14: MedicareMedicare Eligibility and EnrollmentMedicare CoverageMedicare Participating, Nonparticipating, and Opt-Out ProvidersAdvance Beneficiary Notice of NoncoverageMedicare as Primary and Secondary PayerMedicare Summary NoticeMedicare Billing NotesMedicare Claims InstructionsMedicare and Medigap Claims InstructionsMedicare-Medicaid (Medi-Medi) Crossover Claims InstructionsMedicare as Secondary Payer Claims InstructionsMedicare Roster Billing for Mass Vaccination Programs Claims InstructionsSummaryInternet LinksReviewChapter 15: MedicaidMedicaid EligibilityMedicaid CoverageMedicaid ReimbursementMedicaid Billing NotesMedicaid Claims InstructionsMedicaid as Secondary Payer Claims InstructionsMedicaid Mother/Baby Claims InstructionsCHIP Claims InstructionsSummaryInternet LinksReviewChapter 16: TRICARETRICARE HistoryTRICARE AdministrationCHAMPVATRICARE CoverageTRICARE Billing NotesTRICARE Claims InstructionsTRICARE as Secondary Payer Claims InstructionsTRICARE and Supplemental Coverage Claims InstructionsSummaryInternet LinksReviewChapter 17: Workers’ CompensationFederal and State Workers’ Compensation ProgramsEligibility for Workers’ Compensation CoverageClassification and Billing of Workers’ Compensation CasesWorkers’ Compensation and Managed CareForms and ReportsAppeals and AdjudicationFraud and AbuseWorkers’ Compensation Billing NotesWorkers’ Compensation Claims InstructionsSummaryInternet LinksReviewAppendix I: FormsAppendix II: Dental Claims ProcessingAppendix III: AbbreviationsBibliographyGlossaryIndex
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