Medical Insurance Made Easy

Understanding the Claim Cycle


  • Jill Brown, RN, CPC, CPC- H, Computerized Services of Central Florida

This combination textbook and workbook, explains each phase of the medical claim cycle, from the time the patient calls for an appointment until the financial transaction for the encounter is completed. Coverage includes types of insurance payers, basic coding and billing rules, and standard requirements for outpatient billing using the CMS-1500 claim form. It also emphasizes legal aspects related to each level of the medical claim cycle and the importance of the medical office employee, showing their responsibility for and impact on successful reimbursement.
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Book information

  • Published: December 2005
  • Imprint: SAUNDERS
  • ISBN: 978-0-7216-0556-2

Table of Contents

1. Learning to Speak the Language
2. You’re Part of a Team
3. How the Medical Claim Cycle Works
4. CMS-1500 Claim Form
5. Basic Principles for Diagnosis Coding
6. Basic Principles for Evaluation and Management (E/M) Services
7. Basic Principles of Procedure Coding
8. Private Indemnity and Managed Care Medical Plans
9. Other Plans with Medical Coverage and Disability Plans
10. Medicare
11. Other Government Medical Plans
12. Hospital/Facility Rules
13. Reimbursement Success
14. Developing Critical Thinking Skills: Analyzing Problems and Making Decisions
Appendix A Lake Eola Family Practice Associates
Appendix B 1997 Examination Tables
Appendix C Department of Insurance Guide
Appendix D Quick Guide to HIPAA for the Physician’s Office