cover image - Fordney’s Medical Insurance and Billing - Elsevier eBook on VitalSource, 17th Edition
ISBN: 9780443110467
Copyright: 2026
Publication Date: 01-08-2025
Page Count: 560
Imprint: Saunders
List Price: $126.99

Fordney’s Medical Insurance and Billing - Elsevier eBook on VitalSource, 17th Edition

by Linda M. Smith, CPC, CPC-1, CEMC, CMBS and Cheryl Fassett

Elsevier eBook on VitalSource

cover image - Fordney’s Medical Insurance and Billing - Elsevier eBook on VitalSource, 17th Edition
ISBN: 9780443110467
Copyright: 2026
Publication Date: 01-08-2025
Page Count: 560
Imprint: Saunders
List Price: $126.99
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**2026 Textbook and Academic Authors Association (TAA) McGuffey Longevity Award Winner**

Gain the skills you need to succeed in insurance coding and billing! Fordney’s Medical Insurance and Billing, 17th Edition helps you master the insurance billing specialist’s role and responsibilities in areas such as diagnostic coding, procedural coding, HCPCs coding, medical documentation, billing, and collection. Using clear explanations, this book covers all types of insurance coverage commonly encountered in hospitals, physicians’ offices, and clinics. Step-by-step guidelines lead you through the submission of electronic claims and paper claims, as well as the job search and professional advancement. Written by coding specialist and educator Linda M. Smith, this market-leading text is a complete guide to becoming an efficient insurance billing specialist.
    • NEW HCPCs Coding chapter covers ambulance billing, supply billing, and certificates of medical necessity
    • NEW! Content on professionalism includes customer service, conflict management, diversity awareness, leadership, and other competencies to help you become an effective, engaged, and highly functioning employee
    • NEW! Additional content on medical decision making helps you select the appropriate evaluation and management codes under the current documentation guidelines
    • NEW! Additional examples of CMS claims include those from Blue Shield and Automobile Insurance
    • NEW! Updates to credentialing include those specific to Medicare, Medicaid, and Workers’ Compensation
    • Coverage of medical documentation, diagnostic coding, and procedural coding provides you with the foundation and skills needed to work in a physician’s office as well as ambulatory and inpatient settings
    • Coverage of the role and responsibilities of the insurance billing specialist emphasizes advanced job opportunities and certification
    • Chapter on HIPAA compliance as well as Compliance Alerts highlight important HIPAA compliance issues and the latest regulations
    • Step-by-step procedures detail common responsibilities of the insurance billing specialist and coder
    • Key terms and abbreviations are defined and emphasized, reinforcing your understanding of new concepts and terminology
    • Color-coded icons denote and clarify information, rules, and regulations for each type of payer
    • Insights From The Field includes more interviews with experienced insurance billing specialists, providing a snapshot of their career paths and offering advice to the new student
    • Scenario boxes help you apply concepts to real-world situations
    • Quick Review sections summarize chapter content and also include review questions
    • Student Software Challenge on the Evolve website allows you to practice filling out interactive CMS-1500 forms
  • Unit 1 Career Role and Responsibilities
    1. Role of an Insurance Billing Specialist
    2. Privacy, Security, and HIPAA
    3. Compliance, Fraud, and Abuse

    Unit 2 Introduction to Health Insurance
    4. Basics of Health Insurance
    5. The Blue Plans, Private Insurance, and Managed Care Plans
    6. Medicare
    7. Medicaid and Other State Programs
    8. TRICARE and Veterans Health Care
    9. Workers’ Compensation, Automobile, and Liability Insurance
    10. Disability Income Insurance and Disability Benefit Programs

    Unit 3 Documentation and Coding for Professional Services
    11. Medical Documentation and the Electronic Health Record
    12. ICD-10-CM Coding
    13. CPT Coding
    14. HCPCS Level II Coding

    Unit 4 Claims Submission in the Medical Office
    15. The Paper Claim CMS 1500
    16. The Electronic Claim

    Unit 5 Revenue Cycle Management
    17. Receiving Payments and Insurance Problem-Solving
    18. Collection Strategies

    Unit 6 Health Care Facility Billing
    19. Introduction to Health Care Facilities and Ambulatory Surgery Centers
    20. Billing for Health Care Facilities

    Unit 7 Employment
    21. Seeking a Job and Attaining Professional Advancement
  • Linda M. Smith, CPC, CPC-1, CEMC, CMBS, Training and Consulting, MedOffice Resources, Greene, NY, USA and Cheryl Fassett
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