Workbook for Fordney’s Medical Insurance and Billing

16th Edition - December 13, 2021
Author: Linda M. Smith
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 7 9 5 3 6 - 4
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 8 1 0 7 8 - 4

Get hands-on practice in medical insurance billing and coding! Corresponding to the chapters in Fordney's Medical Insurance and Billing, 16th Edition, this workbook provides… Read more

Workbook for Fordney’s Medical Insurance and Billing

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Get hands-on practice in medical insurance billing and coding! Corresponding to the chapters in Fordney's Medical Insurance and Billing, 16th Edition, this workbook provides realistic exercises that help you apply concepts and develop the critical thinking skills needed by insurance billing specialists. Review questions reinforce your understanding of your role and responsibilities, and assignments ask you to complete claim forms by extracting information from patient records and properly selecting procedural and diagnostic codes. Not only will you master the CMS-1500 and 837P claim forms, but you will understand each stage of an insurance claim.

Cover image
Title page
Table of Contents
Copyright
Contributor
Instruction Guide to the Workbook
Learning Objectives
Instructions to the Student
Key Terms and Key Abbreviations
Note Taking
Review Question Assignments
Simulation Assignments
Medical Terminology and Abbreviations
Patient Records
Financial Records
Cms-1500 Claim Form
Performance Evaluation Checklist
Student Reference Notebook
Tests
Reference Material
Employee Insurance Procedural Manual
Unit One: Career Roles and Responsibilities
1. Role of an Insurance Billing Specialist
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 1.1 Review Questions
Criticalthinking
Assignment 1.2 Critical Thinking
Assignment 1.3 Visit Websites
Assignment 1.4 Compose Email Messages
2. Privacy, Security, and HIPAA
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 2.1 Review Questions
Assignment 2.2 Critical Thinking: Incidental Disclosure Versus Hipaa Violation
Assignment 2.3 Visit Websites
3. Compliance, Fraud, and Abuse
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 3.1 Review Questions
Assignment 3.2 Critical Thinking: Fraud Versus Abuse
Assignment 3.3 Visit Websites
Unit Two: Introduction to Health Insurance
4. Basics of Health Insurance
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 4.1 Review Questions
Assignment 4.2 Critical Thinking: Administrative Sequence of Processing an Insurance Claim
Assignment 4.3 Critical Thinking: Differences in Insurance Keyterms
Assignment 4.4 Abstract Data from an Insurance Identification Card
Assignment 4.5 Abstract Data from an Insurance Identificationcard
Assignment 4.6 Abstract Data from an Insurance Identification card
5. The Blue Plans, Private Insurance, and Managed Care Plans
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 5.1 Review Questions
Assignment 5.2 Obtain Authorization for a Consultation from a Managed Care Plan
Assignment 5.3 Obtain Authorization for Physical Therapy from a Managed Care Plan
Assignment 5.4 Obtain Authorization for Diagnostic Arthroscopy from a Managed Care Plan
Assignment 5.5 Obtain Authorization for Consultation from a Managed Care Plan
Assignment 5.6 Obtain Authorization for Diagnostic Body Scan from a Managed Care Plan
6. Medicare
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 6.1 Review Questions
Assignment 6.2 Calculate Mathematical Problems
Assignment 6.3 Complete a Medicare Advance Beneficiary Notice of Noncoverage
7. Medicaid and Other State Programs
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 7.1 Review Questions
Assignment 7.2 Critical Thinking
8. TRICARE and Veterans’ Health Care
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 8.1 Review Questions
Assignment 8.2 Critical Thinking
9. Workers’ Compensation
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 9.1 Review Questions
Assignment 9.2 Complete a Doctor’s First Report of Occupational Injury or Illness Form for a Workers’ Compensation Case
Assignment 9.3 Complete a Doctor’s First Report of Occupational Injury or Illness form for a Workers’ Compensation Case
10. Disability Income Insurance and Disability Benefits Programs
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 10.1 Review Questions
Assignment 10.2 Complete a State Disability Insurance Form
Assignment 10.3 Complete a State Disability Insurance Form
Assignment 10.4 Complete a State Disability Insurance Form
Assignment 10.5 Complete a State Disability Insurance Form
Unit Three: Documentation and Coding for Professional Services
11. Medical Documentation and the Electronic Health Record
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 11.1 Review Questions
Assignment 11.2 Critical Thinking: Solve an Office Problem
Assignment 11.3 Abstract Subjective Observations and Objective Findings from Patient Records
Assignment 11.4 Review of a Patient Record
Assignment 11.5 Review an Operative Report
Assignment 11.6 Review Radiology Record
Assignment 11.7 Review Pathology/Laboratory Report
Assignment 11.8 Review Physical Therapy Record
12. Diagnostic Coding
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 12.1 Review Questions
Assignment 12.2 Locating Information in Icd-10-Cm, Volume 2
Diagnostic Coding Assignments
Assignment 12.3 Obtain General Diagnostic Codes for Conditions
Assignment 12.4 Code Diagnoses from Medical Records
Assignment 12.5 Code Diagnoses Using Z Codes
Assignment 12.6 Code Neoplastic Diagnoses
Assignment 12.7 Code Diagnoses for Patients With Diabetes
Assignment 12.8 Code Diagnoses for Patients with Hypertension
Assignment 12.9 Code Diagnoses for Injuries, Fractures, Burns, Late Effects, and Complications
Assignment 12.10 Code Diagnoses for Pregnancy, Delivery, and Newborn Care
Assignment 12.11 Code Diagnoses Using Table of Drugs and Chemicals
13. Procedural Coding
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 13.1 Review Questions
Procedure Coding Assignments
Assignment 13.2 Introduction to CPT and Coding Evaluation and Management Services
Assignment 13.3 Code Anesthesia Problems
Assignment 13.4 Code Surgical Problems
Assignment 13.5 Code Problems for Radiology and Pathology
Assignment 13.6 Procedure Code and Modifier Problems
Assignment 13.7 Hcpcs/Modifier Code Match
Assignment 13.8 Procedural Coding Case Scenarios
Assignment 13.9 Case Scenario for Critical Thinking
Assignment 13.10 Calculate Fees Based on Resource-Based Relative Value System
Unit Four: Claims Submission in the Medical Office
14. The Paper Claim: CMS-1500
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 14.1 Review Questions
Part III Multiple Choice
Part IV True/False
Assignment 14.2 Complete a Health Insurance Claim Form for a Private Case
Assignment 14.3 Complete One Health Insurance Claim Form for a Private Case
Assignment 14.4 Locate Errors on a Completed Health Insurance Claim Form
Assignment 14.5 Complete a Claim Form for a Medicare/Medicaid Case
Assignment 14.6 Complete a Claim Form for a Medicare Case
Assignment 14.7 Complete a Claim Form for a Medicaid Case
Assignment 14.8 Complete a Claim Form for a Medicaid Case
Assignment 14.9 Complete a Claim Form for a Tricare Standard Case
Assignment 14.10 Complete a Claim Form for a Tricare Extra Case
Assignment 14.11 Complete a Claim Form for a Workers’ Compensation Case
Assignment 14.12 Complete a Claim Form for a Workers’ Compensation Case
15. The Electronic Claim
Key Terms
Key abbreviations
Performance Objectives
Study Outline
Assignment 15.1 Review Questions
Assignment 15.2 Input Data Into Element for Place of Service Codes for 837P Electronic Claims Submissions
Assignment 15.3 Select the Correct Individual Relationship Code Number for 837P Electronic Claims Submission
Assignment 15.4 Select the Correct Taxonomy Codes for Medical Specialists for 837P Electronic Claims Submission
Unit Five: Revenue Cycle Management
16. Receiving Payments and Insurance Problem Solving
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 16.1 Review Questions
Assignment 16.2 Using an Aging Report for Follow-Up
Assignment 16.3 Post to a Financial Accounting Record (Ledger) from an Explanation of Benefits (Eob) Document
Assignment 16.4 Locate Errors on a Returned Insurance Claim
Assignment 16.5 Locate Errors on a Returned Insurance Claim
Assignment 16.6 Locate Errors on a Returned Insurance Claim
Assignment 16.7 File an Appeal
17. Collection Strategies
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 17.1 Review Questions
Assignment 17.2 Select a Dun Message
Assignment 17.3 Manually Post a Courtesy Adjustment
Assignment 17.4 Manually Post a Patient’s Charges and Payment
Assignment 17.5 Compose a Collection Letter
Assignment 17.6 Accepting Credit Card Payments
Assignment 17.7 Complete a Financial Agreement
Unit Six: Health Care Facility Billing
18. Introduction to Health Care Facilities and Ambulatory Surgery Centers
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 18.1 Review Questions
Critical Thinking Assignments
Assignment 18.3 Calculating MS-DRG
Assignment 18.4 APC Discounting
Assignment 18.5 Critique of the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI)
19. Billing for Health Care Facilities
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 19.1 Review Questions
Part II Mix and Match
Critical Thinking Assignments
Assignment 19.3 Assigning Character 3 for Root Operation (ICD-10-PCS)
Assignment 19.4 Assigning ICD-10-PCS Codes
Assignment 19.5 Completeing The UB-04
Unit Seven: Employment
20. Seeking a Job and Attaining Professional Advancement
Key Terms
Key Abbreviations
Performance Objectives
Study Outline
Assignment 20.1 Review Questions
Assignment 20.2 Job Searching and Job Skills
Assignment 20.3 Complete a Worksheet and Type a Résumé
Assignment 20.4 Complete a Cover Letter
Assignment 20.5 Complete a Job Application Form
Assignment 20.6 Prepare a Follow-Up Thank-You Letter
Assignment 20.7 Visit Websites for Job Opportunities
Assignment 20.8 Critical Thinking
Tests
Test 1: Procedure (E/M and Medicine Sections) and Diagnostic Procedure Code Test
Test 2: Procedure Code with Modifiers and Diagnostic Code Test
Test 3: Procedure (Radiology and Pathology Sections) and Diagnostic Code Test
Test 4: Complete a CMS-1500 Claim Form
Test 5: Complete a CMS-1500 Claim Form
Test 6: Complete a Claim form for a Medicare Case
Test 7: Complete a claim form for a medicare/Medigap case
Test 8: Complete a Claim form for a Medicaid Case
Test 9: Complete a Claim form for a Tricare Case
Test 10: Complete a Claim form for a Private Plan
A. College Clinic Office Policies and Mock Fee Schedule
College Clinic
College Clinic Staff
Abbreviations and Symbols
Abbreviations
Laboratory Abbreviations
Mock Fee Schedule

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Save 50% on book bundles

Immediately download your ebook while waiting for your print delivery. No promo code is needed.

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Linda M. Smith