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
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
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.
- 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.
- Key terms and key abbreviations are defined and emphasized, reinforcing your understanding of new concepts and terminology.
- Detailed tables, boxes, and illustrations call out key points and main ideas.
- Unique! Color-coded icons clarify information, rules, and regulations for different payers.
- An Evolve companion website enhances learning with performance checklists, self-assessment quizzes, and the Student Software Challenge featuring cases for different payer types and an interactive CMS-1500 form to fill in.
- A workbook contains learning tips, practice exercises for key terms and abbreviations, review questions, study outlines, performance objectives, a chapter with practice tests, and critical thinking activities for hands-on experience with real-world cases. Available separately.
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Formerly, Instructor of Medical Insurance, Medical Terminology, Medical Machine Transcription, and Medical Office Procedures, Ventura College, Ventura, CA