Insurance Handbook for the Medical Office


  • Marilyn Fordney, CMA-AC, Formerly, Instructor of Medical Insurance, Medical Terminology, Medical Machine Transcription, and Medical Office Procedures, Ventura College, Ventura, CA

A complete guide to insurance billing and coding, Insurance Handbook for the Medical Office, 13th Edition covers all the plans that are most commonly encountered in clinics and physicians’ offices. Its emphasis on the role of the medical insurance specialist includes areas such as diagnostic coding, procedural coding, Medicare, HIPAA, and bill collection strategies. Learning to fill in the claim form accurately is made easier by the use of icons for different types of payers, lists of key abbreviations, and numerous practice exercises. This edition provides the latest on hot topics such as ICD-10, healthcare reform, the new CMS-1500 form, and electronic claims. Trusted for more than 30 years, this proven reference from Marilyn Fordney prepares you to succeed as a medical insurance professional in any outpatient setting.
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Book information

  • Published: September 2013
  • Imprint: SAUNDERS
  • ISBN: 978-1-4557-3325-5

Table of Contents

Unit 1: Career Roles and Responsibilities

1. Role of an Insurance Billing Specialist

2. Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Unit 2: The Claims Process

3. Basics of Health Insurance

4. Medical Documentation and the Electronic Health Record

5. Diagnostic Coding

6. Procedural Coding

7. The Paper Claim CMS-1500 (02-12)

8. The Electronic Claim

9. Receiving Payments and Insurance Problem-Solving

10. Office and Insurance Collection Strategies

Unit 3: Health Care Payers

11. The Blue Plans, Private Insurance, and Managed Care Plans

12. Medicare

13. Medicaid and Other State Programs

14. TRICARE and Veterans' Health Care

15. Workers’ Compensation

16. Disability Income Insurance and Disability Benefit Programs

Unit 4: Inpatient and Outpatient Billing

17. Hospital Billing

Unit 5: Employment

18. Seeking a Job and Attaining Professional Advancement


Key Abbreviations