Learn to complete and submit clean claim forms for major insurance carriers. Health Insurance Today, 3rd Edition, provides case studies for each of the chapters covering these major payers so you can learn how to abstract the information from the patient’s chart to complete the CMS-1500. You will learn to complete and submit paper claims, but the emphasis is on electronic claims filing, keeping you up-to-date on HIPAA, electronic health records, and the latest industry standards. Select exercises on the companion Evolve Resource site let you gain experience entering information into a practice management program; producing an electronic CMS-1500; and submitting a claim electronically.
- Learning objectives makes learning easier and more meaningful
- Direct, conversational writing style makes reading and absorbing the material more enjoyable
- "What Did You Learn?" review questions ensure that you understand the material already covered, before progressing to the next section.
- "Imagine This!" scenarios help you apply information from the book to real-life situations
- "Stop and Think" exercises let you apply critical thinking skills to solve a problem or answer a question.
- HIPAA Tips help you understand this very important piece of legislation.
- Activities on the Evolve site give you hands-on practice electronically completing a claim form as efficiently as possible.
UNIT 1 - BUILDING A FOUNDATION
1. The Origins of Health Insurance
2. Tools of the Trade: A Career as a Health (Medical) Insurance Professional
3. The Legal & Ethical Side of Medical Insurance
4. Types and Sources of Health Insurance
UNIT 2 – HEALTH INSURANCE BASICS
5. The "Universal" Claim Form: CMS-1500
6. Traditional Fee-For-Service/Private Plans
7. Unraveling the Mysteries of Managed Care
8. Understanding Medicaid
9. Conquering Medicare’s Challenges
10. Military Carriers
11. Miscellaneous Carriers: Worker’s Compensation and Disability Insurance
UNIT 3 – CRACKING THE CODES
12. Diagnostic Coding
13. Procedural, Evaluation & Management and HCPCS Coding
UNIT 4 – THE CLAIMS PROCESS
14. The Patient
15. The Claim
UNIT 5 – ADVANCED APPLICATION
16. The Role of Computers in Health Insurance
17. Reimbursement Procedures: Getting Paid
18. Hospital Claim Form: The UB-04
- © Saunders 2011
- 22nd September 2010
- eBook ISBN:
Southeastern Community College (retired), Administrative Instructor, Medical Assistant Program, West Burlington, IA, USA