Winner of the Text and Academic Authors Association's 2003 Textbook Excellence Award! This completely new full-color worktext presents all aspects of submitting, tracing, appealing, and transmitting claims for today's full range of health plans. Distilled from the comprehensive textbook, Fordney's Insurance Handbook for the Medical Office, this essentials text features a streamlined approach to key topics - including documentation in a medical office, Example boxes, colorful illustrations, and an appendix that uses color-coded payer icons to teach readers how to complete the HCFA-1500 form. Self-study workbook sections and practice exercises incorporated throughout the book make it easy to learn diagnostic coding, procedural coding, office and insurance collection strategies, Medicare considerations, and more. A companion CD-ROM and website offer additional practice and interactive learning opportunities!
- Combined text and workbook format keeps the content self-contained and easy to manage.
- Full-color format allows readers to identify colors and icons with individual payers, helping them to easily follow and learn specific payer rules and procedures.
- An appendix of block-by-block coverage, with full-color examples of the HCFA-1500 insurance claim form, facilitates understanding and effective learning.
- Photographs, quotes, and short biographies of real insurance billing specialists appear in each chapter, offering real-world perspectives on insurance billing.
- A separate chapter on documentation in the medical office is devoted to this critical topic.
- Exercise sections within the text encourage readers to stop and recall or apply what they've learned to help master key concepts.
Section I: Career and Professionalism
Chapter 1 A Career as an Insurance Billing Specialist
Section II: Basics of Health Insurance
Chapter 2 Fundamentals of Health Insurance Coverage
Chapter 3 Source Documents and the Insurance Claim Cycle
Section III: Coding Insurance Claims
Chapter 4 Coding Diagnoses
Chapter 5 Coding Procedures Part I: Introduction to Evaluation and Management Services
Chapter 6 Coding Procedures Part II: Anesthesia, Surgery, Radiology, Pathology/Laboratory, and Medicine
Section IV: Claim Submission
Chapter 7 Documentation and the Medical Record
Chapter 8 The Health Insurance Claim Form: Completion and Submission
Chapter 9 Fees: Private Insurance and Managed Care
Section V: Insurance Programs
Chapter 10 The Medicaid Program
Chapter 11 The Medicare Program
Chapter 12 The TRICARE and CHAMPVA Programs
Chapter 13 Workers' Compensation Coverage and other Disability Programs
Section VI: Receiving Payment and Problem Solving
Chapter 14 Patient Billing and Credit/Collection Practices
Chapter 15 Tracking Reimbursement and Simple Solutions to Unpaid Claims
A College Clinic Medical Practice Simulation
B College Clinic Mock Fee Schedule
C Medicare's National HCPCS Level II Codes and Modifiers
D HCFA-1500 Claim Form Instructions and Insurance Templates
F College Clinic Form File
G Student Software Challenge Installation and Operating Instructions