Unit One: Career Role and Responsibilities
1. Role of an Insurance Billing Specialist
2. HIPAA Compliance and Privacy in Insurance Billing
Unit Two: The Claims Process
3. Basics of Health Insurance
4. Medical Documentation
5. Diagnostic Coding
6. Procedural Coding
7. The Paper Claim: CMS-1500
8. Electronic Data Interchange: Transactions and Security
9. Receiving Payments and Insurance Problem Solving
10. Office and Insurance Collection Strategies
Unit Three: Health Care Payers
11. The Blue Plans, Private Insurance, and Managed Care Plans
13. Medicaid and Other State Programs
14. TRICARE and CHAMPVA
15. Workers' Compensation
16. Disability Income Insurance and Disability Benefit Insurance
Unit Four: Inpatient and Outpatient Billing
17. Hospital Billing
Unit Five: Employment
18. Seeking a Job and Attaining Professional Advancement
A complete guide to the latest in insurance billing and coding, Insurance Handbook for the Medical Office, 12th Edition covers all the plans that are most commonly encountered in clinics and physicians' offices. An emphasis on the role of the medical insurance specialist prepares you for success in the workplace, including 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. Written by insurance billing expert Marilyn Fordney, this comprehensive, market-leading resource has been trusted for more than 30 years.
- Emphasis on the business of running a medical office highlights the importance of the medical insurance specialist in filing clean claims, solving problems, and collecting overdue payments.
- Block-by-block explanations and examples demonstrate the correct way to complete the CMS-1500 claim form.
- Compliance Alerts and a HIPAA Compliance and Privacy in Insurance Billing chapter highlight important HIPAA compliance issues and ensure that you are aware of, and compliant with, governmental privacy regulations.
- A guide to receiving payments and to insurance collection is provided in separate chapters.
- A Medical Documentation chapter covers the principles of documentation and shows how proper documentation can prevent penalties and refund requests, and help you prove compliance in the case of an audit or review.
- Guidelines for the filing and submission of electronic claims prepare you for the industry-wide transition to an electronic environment.
- Unique! Color-coded icons clarify information, rules, and regulations for different payers.
- Form icons and Computer icons ease the transition from paper to electronic filing.
- Service to Patient features offer examples of quality customer service.
- Seeking a Job chapter gives tips and techniques on securing that first job.
- Key points summarize important chapter content.
- Key terms are bolded at first mention, defined, and emphasized throughout.
- A companion Evolve website enhances learning with performance checklists, self-assessment quizzes, and the Student Software Challenge featuring cases for diffe
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Formerly, Instructor of Medical Insurance, Medical Terminology, Medical Machine Transcription, and Medical Office Procedures, Ventura College, Ventura, CA