Description: Understanding Health Insurance, Tenth Edition is fully updated to the latest code sets, guidelines, and claim forms to provide you with the most essential and up-to-date knowledge on billing and reimbursement.
With Understanding Health Insurance, Tenth Edition, you will learn about managed health care, legal and regulatory issues, coding systems, reimbursement methods, coding for medical necessity, and common health insurance plans. Exercises in each chapter provide plenty of practice for learning how to bill and reimburse, and the accompanying workbook provides more application-based assignments for each chapter as well as additional case studies to reinforce your knowledge. The text includes free software that allows you to test your knowledge. Product Benefits: - ICD-10-CM Coverage- Chapter 6 includes an overview of ICD-10-CM and ICD-10-PCS, and ICD-10-CM codes now included alongside ICD-9-CM codes in chapters 11 through 17.
- Chapter 1 now focuses on professionalism and health insurance career opportunities, internships, and interpersonal skills.
- New content covering medical documentation and the electronic health record (EHR) added to Chapter 2.
- Chapter 4 renamed Processing an Insurance Claim and includes new content about electronic data interchange (EDI).
- SimClaim CMS-1500 practice software has improved functionality in feedback mode, targeted block help with video, and the option to print completed forms to PDF for easy emailing.
- Alerts such as the HIPAA Alerts, Coding Tips, ICD-10, and Managed Care Alerts draw attention to critical areas of content and provide experience-based recommendations.
- Notes appear throughout and clarify content, give references, provide background, or emphasize rule exceptions.
- Study Checklist at the end of each chapter directs you to other learning aids to enhance understanding and build confidence.
- Free StudyWare™ CD-ROM provides chapter quizzes and games for practice and self-testing, and features unique Coding Case Studies with animations and video to challenge your ICD-9-CM, CPT, and HCPCS Level II coding skills.
- 30-day free trial of Encoder Pro™ from Ingenix lets you look up codes and descriptions quickly and with greater accuracy.
Table of Contents: 1. Health Insurance Specialist Career.
2. Introduction to Health Insurance.
3. Managed Health Care.
4. Processing of an Insurance Claim.
5. Legal and Regulatory Issues.
6. ICD-9-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding for Medical Necessity.
11. Essential CMS-1500 Claim Instructions.
12. Commercial Insurance.
13. Blue Cross Blue.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers' Compensation.
APPENDICES.
Bibliography.
Glossary.
Index. |
