Description: Understanding Health Insurance, Eleventh Edition, is the essential learning tool you need when preparing for a career in medical insurance billing. This comprehensive and easy-to-understand text is fully-updated with the latest code sets and guidelines, and covers important topics in the field like managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. The eleventh edition has been updated to include new legislation that affects healthcare, ICD-10-CM coding, implementing the electronic health record, the Medical Integrity Program (MIP), medical review process, and more. The practice exercises in each chapter provide plenty of review, and the accompanying workbook provides even more application-based assignments and additional case studies for reinforcement. Includes free online StudyWARE™ software that allows you to test your knowledge, free online SimClaim™ CMS-1500 claims completion software, and free-trial access to Ingenix's EncoderPro.com—Expert encoder software. Product Benefits: - ICD-10-CM Coverage- New chapter 6b includes covers ICD-10-CM and includes an overview of ICD-10-PCS to bridge the transition in the classroom.
- Fully updated to the latest available code sets; ICD-10-CM code mapping included in relevant chapters.
- Expanded content covering medical documentation and the electronic health record (EHR) added to Chapter 2.
- Chapter 5 includes new legislation and coverage of the Medical Integrity Program (MIP), medical review process, and HIPAA's Title III.
- SimClaim CMS-1500 practice software has been updated to map to the textbook claims completion instructions, with 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™ online practice software 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, ICD-10-CM, CPT, and HCPCS Level II coding skills.
- 59-day free trial of Encoder Pro.com—Expert™ 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 an Insurance Claim.
5. Legal and Regulatory Issues.
6A. ICD-9-CM Coding.
6B. ICD-10-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 Shield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers' Compensation.
Appendices.
Bibliography.
Glossary.
Index. |
