Medical Insurance Made Easy: A Worktext
This combination textbook and workbook provides a complete overview of the medical claim process from initial patient appointment through final financial transaction. Chapters discuss types of insurance payors, basic coding and billing rules. Also discussed are standard requirements for outpatient billing using the HCFA-1500 claim form. Legal aspects for each level of the medical claim cycle are also included. Throughout the book, strong emphasis is placed on the medical office employee's responsibility for successful reimbursement.
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How the Medical Claim Cycle Works
Private Indemnity and Managed Care Medical Plans
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1999 American Medical Abbreviation American Medical Association amount and/or audits blood body CHAMPUS Chapter charge chart circulatory system claim form clinical co-payment codebook collect complete correct coverage covered CPT codes determine diagnosis codes disease E-codes E/M code E/M services electronic eligibility employees entered exam fee schedule Figure glands HCFA-1500 claim form HCPCS HIPAA hospital ical ID number identified indemnity plans injury inpatient insurance company insurance plan Lake Eola listed main term Medicaid medical claim form medical decision medical insurance medical necessity medical office medical plan medical record Medicare Medicare Part-B Medicare+Choice Medigap ment modifiers patient's medical payment payor contracts penalties performed physi physician primary payor problem procedure code RBRVS received reimbursement responsible rules RVUs secondary payor service or procedure shows block specific SuperBill surgical tests tient tion treatment TRICARE True False write-off