Health Insurance Today,5th Edition
With an emphasis on preparing and filing claims electronically, Health Insurance Today, 4th Edition features completely updated content on ICD-10 coding, ARRA, HI-TECH, Version 5010, electronic health records, the Health Insurance Reform Act, and more. The friendly writing style and clear learning objectives help you understand and retain important information, with review questions and activities that encourage critical thinking and practical application of key concepts.
- Clear, attainable learning objectives help you focus on the most important information.
- What Did You Learn? review questions allow you to ensure you understand the material already presented before moving on to the next section.
- Direct, conversational writing style makes reading fun and concepts easier to understand.
- Imagine This! scenarios help you understand how information in the book applies to real-life situations.
- Stop and Think exercises challenge you to use your critical thinking skills to solve a problem or answer a question.
- HIPAA Tips emphasize the importance of privacy and following government rules and regulations.
- Chapter summaries relate to learning objectives, provide a thorough review of key content, and allow you to quickly find information for further review.
- Key coverage of new topics includes medical identity theft and prevention, National Quality Forum (NQF) patient safety measures, ACSX12 Version 5010 HIPAA transaction standards, EMS rule on mandatory electronic claims submission, and standards and implementation specifications for electronic health record technology.
- Increased emphasis on producing and submitting claims electronically gives you an edge in today’s competitive job market.
- UPDATED! Additional ICD-10 coding content prepares you for the upcoming switch to the new coding system.
NEW! Content on ARRA, HI-TECH, and the Health Insurance Reform Act ensures you are familiar with the latest health care legislation and how it impacts what you do on the job.
Unit 1: Building a Foundation 1. The Origins of Health Insurance 2. Tools of the Trade: A Career as a Health (Medical) Insurance Professional 3. The Legal and Ethical Side of Medical Insurance 4. Types and Sources of Health Insurance
Unit 2: Health Insurance Basics 5. Claim Submission Methods 6. Traditional Fee-for-Service/Private Plans 7. Unraveling the Mysteries of Managed Care 8. Understanding Medicaid 9. Conquering Medicare’s Challenges 10. Military Carriers 11. Miscellaneous Carriers: Workers’ Compensation and Disability Insurance
Unit 3: Cracking the Codes 12. Diagnostic Coding 13. Procedural, Evaluation and Management, and HCPCS Coding Unit 4: The Claims Process 14. The Patient 15. Keys to Successful Claims Management
Unit 5: Advanced Application 16. The Role of Computers in Health Insurance 17. Reimbursement Procedures: Getting Paid 18. Hospital Billing and the UB-04 Appendix A: Sample Blank CMS-1500 (02-12) Appendix B: CMS-1500 Claim Forms and Completion Instructions Appendix C: UB-04 Claim Form and Completion Instructions Glossary
Janet I. Beik, AA, BA, MEd, Southeastern Community College (retired), Administrative Instructor, Medical Assistant Program, West Burlington, IA, USA