Understanding Health Insurance: A Guide to Billing and Reimbursement

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Cengage Learning, Feb 3, 2012 - Business & Economics - 800 pages
Understanding Health Insurance, Eleventh Edition, is the essential learning tool you need when preparing for a career in medical insurance billing. This comprehensive and easy-to-understand text is fully-updated with the latest code sets and guidelines, and covers important topics in the field like managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. The eleventh edition has been updated to include new legislation that affects healthcare, ICD-10-CM coding, implementing the electronic health record, the Medical Integrity Program (MIP), medical review process, and more. The practice exercises in each chapter provide plenty of review, and the accompanying workbook—sold separately—provides even more application-based assignments and additional case studies for reinforcement. Includes free online StudyWARETM software that allows you to test your knowledge, free online SimClaimTM CMS-1500 claims completion software, and free-trial access to Ingenix's EncoderPro.com—Expert encoder software.
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This book set a essential guidelines you need when your are preparing for a career in medical insurance

Contents

Health Insurance Specialist Career
1
Introduction to Health Insurance
21
Managed Health Care
41
Processing an Insurance Claim
59
Legal and Regulatory Issues
101
ICD9CM Coding
143
ICD10CM Coding
201
CPT Coding
263
Commercial Insurance
471
Blue Cross Blue Shield
495
Medicare
523
Medicaid
569
TRICARE
601
Workers Compensation
631
Appendices
655
Bibliography
741

HCPCS Level II Coding
339
CMS Reimbursement Methodologies
359
Coding for Medical Necessity
411
Essential CMS1500 Claim Instructions
445
Glossary
745
Index
773
Copyright

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About the author (2012)

Distinguished Teaching Professor in the Health Information Technology Department at Mohawk Valley Community College in Utica, New York. She also teaches in the Health Information Management Department at Mount Wachusett Community College in Gardner, Massachusetts. Ms. Green held the position of SUNY Distinguished Teaching Professor in the Physical and Life Sciences Department at the State University of New York, College of Technology from 1984 through 2016. An active member of the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA), Ms. Green has been recognized both for her excellence in teaching and for her significant contributions to the health information management profession. She has earned numerous awards, including the State University of New York Chancellor's Award for Excellence in Teaching, Alfred State College's Alumni Association Teacher of the Year, Who's Who Among America's Teachers and AHIMA's FORE Triumph Educator Award. Ms. Green is a Registered Health Information Administrator (RHIA), a Fellow of the American Health Information Management Association (FAHIMA) and a Certified Procedural Coder (CPC). She earned a B.S. from Daemen College and an M.P.S. degree from Alfred University. Ms. Green has authored three successful textbooks related to coding and health information management.

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