Keep current with all the latest changes with this complete resource! Trusted by medical insurance instructors and billers for more than 30 years, Insurance Handbook for the Medical Office helps you excel at all aspects of insurance billing for a full range of today's health care plans. In full color, this edition includes all the new regulations, such as the latest information on HIPAA, diagnostic coding, procedural coding, bill collection strategies, and Medicare.
- Meticulously reviewed by a panel of industry experts.
- Emphasis on the business of running a medical office highlights the importance of the medical insurance specialist's role in filing clean claims, solving problems, and collecting overdue payments.
- Key terms are bolded at first mention, explained within the context of the discussion, and defined in the glossary.
- Key points summarize important chapter content.
- Block-by-block explanations and examples demonstrate the correct way to complete the CMS-1500 claim form.
- Completed sample insurance forms apply concepts to real life.
- Unique payer icons clarify CMS claim form completion.
- Form icons and Computer icons ease the transition from paper to electronic filing.
- Special HIPAA Alerts ensure compliance with governmental privacy regulations.
- Guidelines for the filing and submission of electronic claims include the do’s and don’ts for the electronic environment.
- Service to Patient features discuss ways to provide quality service to the patient as well as to your co-workers.
- A documentation chapter covers the principles of documentation and shows how proper documentation can prevent penalties and refund requests, and help you prove compliance in the case of an audit or review.
- An Evolve website includes supplemental Medisoft activities, self-assessment quizzes, updates of content, and web links for further research and study.
- A workbook contains learning tips, review exercises, cases, and critical thinking activities for hands-on experience with real-world cases. (Available separately.)
- Updated learning objectives correlate directly to the text, making it easier to study and to measure your progress.
- New CMS-1500 form filler software on Evolve provides additional exercises for hands-on practice.
Unit One: Career Roles and Responsibilities
1. Role of an Insurance Billing Specialist
2. HIPAA Compliance and Privacy in Insurance Billing
Unit Two: The Claims Process
3. Basics of Health Insurance
4. Medical Documentation
5. Diagnostic Coding
6. Procedural Coding
7. The Paper Claim: CMS-1500 (08-05)
8. Electronic Data Interchange: Transactions and Security
9. Receiving Payments and Insurance Problem Solving
10. Office and Insurance Collection Strategies
Unit Three: Health Care Payers
11. The Blue Plans, Private Insurance and Managed Care Plans
13. Medicaid and Other State Programs
14. TRICARE and CHAMPVA
15. Workers’ Compensation
16. Disability Income Insurance and Disability Benefit Programs
Unit Four: Inpatient and Outpatient Billing
17. Hospital Billing
Unit Five: Employment
18. Seeking a Job and Attaining Professional Advancement