Understanding Hospital Billing and Coding,3rd Edition
A basic guide to hospital billing and reimbursement, Understanding Hospital Billing and Coding, 3rd Edition helps students understand, complete, and submit the UB-04 claim form that is used for all Medicare and privately insured patients. It describes how hospitals are reimbursed for patient care and services, showing how the UB-04 claim form reflects the flow of patient data from the time of admission to the time of discharge. With this text, students will also learn the essentials of ICD-10-CM and develop skills in both inpatient coding and outpatient/ambulatory surgery coding.
- UB-04 Claim Simulation on the companion Evolve website lets you practice entering information from source documents into the claim form.
- Over 300 illustrations and graphics bring important concepts to life.
- Detailed chapter objectives highlight what you are expected to learn.
- Key terms, acronyms, and abbreviations with definitions are included in each chapter.
- Concept Review boxes reinforce key concepts.
- Test Your Knowledge exercises reinforce lessons as you progress through the material.
- Chapter summaries review key concepts.
- Practice hospital cases let you apply concepts to real-life scenarios.
- UPDATED content reflects the most current industry changes in ICD-10, MR-DRGs, PPS Systems, and the Electronic Health Record.
- NEW Hospital Introduction chapter includes a department-by-department overview showing how today’s hospitals really work
- NEW Health Care Payers and Reimbursement section follows the workflow of the hospital claim by including successive chapters on payers, prospect payment systems, and accounts receivable management.
Section 1: Hospital Overview
1. Hospital Introduction
2. Hospital Regulatory Environment
Section 2: Hospital Billing and Coding Process
4. Patient Accounts Data Flow
5. Hospital Billing Process
Section 3: Coding
6. ICD-9-CM Diagnosis and Procedure Coding
7. ICD-10-CM Diagnosis Coding
8. Procedure Coding (HCPCS and ICD-10-PCS)
9. Coding Guidelines and Applications (HCPCS and ICD-10-CM/PCS)
Section 4: Claim Forms
10. Claim Forms
Section 5: Health Care Payers and Reimbursement
12. Prospective Payment Systems
13. Accounts Receivable Management
Section 6: Appendixes
B: Claim Form Data
C: Web Resources
Debra P. Ferenc, BS, CPC, CPC-I, CPC-H, CMSCS, PCS, FCS