A basic guide to hospital billing and reimbursement, Understanding Hospital Billing and Coding, 3rd Edition helps you understand, complete, and submit the UB-04 claim form that is used for all Medicare and privately insured patients. It describes how hospitals are reimbursed for patient care and services, showing how the UB-04 claim form reflects the flow of patient data from the time of admission to the time of discharge. Written by coding expert Debra P. Ferenc, this book also ensures that you understand the essentials of ICD-10-CM and develop skills in both inpatient coding and outpatient/ambulatory surgery coding.
- UB-04 Claim Simulation on the companion Evolve website lets you practice entering information from source documents into the claim form.
- Over 300 illustrations and graphics bring important concepts to life.
- Detailed chapter objectives highlight what you are expected to learn.
- Key terms, acronyms, and abbreviations with definitions are included in each chapter.
- Concept Review boxes reinforce key concepts.
- Test Your Knowledge exercises reinforce lessons as you progress through the material.
- Chapter summaries review key concepts.
- Practice hospital cases let you apply concepts to real-life scenarios.
Section 1: Hospital Overview
1. Hospital Introduction
2. Hospital Regulatory Environment
Section 2: Hospital Billing and Coding Process
4. Patient Accounts Data Flow
5. Hospital Billing Process
Section 3: Coding
6. ICD-9-CM Diagnosis and Procedure Coding
7. ICD-10-CM Diagnosis Coding
8. Procedure Coding (HCPCS and ICD-10-PCS)
9. Coding Guidelines and Applications (HCPCS and ICD-10-CM/PCS)
Section 4: Claim Forms
10. Claim Forms
Section 5: Health Care Payers and Reimbursement
12. Prospective Payment Systems
13. Accounts Receivable Management
Section 6: Appendixes
B: Claim Form Data
C: Web Resources