Description

For courses in Medical Insurance,  Medical Billing and Coding and Health Claims Reimbursement.  

 

Advanced Medical Billing and Coding: A Reimbursement Approach offers an innovative look at the complete billing, coding and medical claims reimbursement process. Its unique dual perspective considers the roles of the medical billing and coding professional and the health claims examiner. An extensive revision, this edition includes the new ICD-10 code set, the most current billing forms, and coverage of the most recent healthcare legislations. Four new chapters focus on processing medical claims for Non-Medicare, Medicare and Workers' Compensation. With its balanced perspective, students learn the perspectives of both the medical office and insurance company which prepares them for the complete billing, coding, and reimbursement cycle.

Features

For courses in Medical Insurance,  Medical Billing and Coding and Health Claims Reimbursement.  

 

Advanced Medical Billing and Coding: A Reimbursement Approach offers an innovative look at the complete billing, coding and medical claims reimbursement process. Its unique dual perspective considers the roles of the medical billing and coding professional and the health claims examiner. An extensive revision, this edition includes the new ICD-10 code set, the most current billing forms, and coverage of the most recent healthcare legislations. Four new chapters focus on processing medical claims for Non-Medicare, Medicare and Workers' Compensation. With its balanced perspective, students learn the perspectives of both the medical office and insurance company which prepares them for the complete billing, coding, and reimbursement cycle.

 

Features

 

Provides an advanced look at medical billing and coding—preparing students for the complete reimbursement cycle, from coding, billing, auditing, to reimbursement and resubmission of denied or pended claims.

 

Offers a dual perspective—that considers the job duties of medical billing and coding professionals and health claims examiners.

 

Covers advanced concepts—including hospital coding and billing, workers' compensation, Medicare, Medicaid, and managed care practice.

 

Discusses the intermediary/carrier perspectives and the insurance company perspectives—sostudents learn the gamut of insurance billing, coding, and examining/reimbursement strategies.

 

Offers a practice based model—including a variety of applications such as Activities, Practice Pitfalls and Critical Thinking Questions.  

New to this Edition

This third edition is revised to include the new ICD-10-CM code set, updated healthcare legislations, and a new focus on how to process various types of claims. New Activities, Critical Thinking Questions, and Practice Pitfalls keep your course current.

 

Updated information on the following legislative actions:

• The Healthcare Insurance Portability and Accountability Act (HIPAA)
• Health Information Technology for Economic and Clinical Health Act (HITECH)
• Patient Protection and Affordable Care Act
• OIG Corporate Compliance Act

Four new chapters focusing on claims processing including:

• Chapter 11: Claims Examination
• Chapter 12: Processing Non-Medicare Claims
• Chapter 13: Processing Medicare Claims
• Chapter 14: Processing Workers' Compensation Claims

Revised Chapter 1: Introduction to Technical and Legal Issues updates information on new healthcare legislation and requirements for electronic reimbursement procedures.

 

Revised Chapter 2: Resource Manuals and Billing Forms includes the CMS-1500 Form and UB-04 with step-by-step instructions for accurate completion.

 

Revised Chapter 3: Contract Interpretation and Administration includes mandated changes from HIPAA, HITECH, and the PPACA.

 

Revised Chapter 4: Medical Benefit shows the impact of new legislation on insurance companies.

 

Coverage of ICD-10-CM/PCS code sets includes transitions and the new CPT codes.

 

New Critical Thinking questions challenge students to apply textbook material to real life work dilemmas.

 

New case studies, physician notes, encounter forms, history and physicals keeps activities fresh and current.

Table of Contents

SECTION I: INTRODUCTION TO ISSUES RELATED TO HEALTH CLAIMS PROCESSING

1.    Introduction to Technical and Legal Issues

2.    Resource Manuals and Billing Forms

 

SECTION II: CONTRACT INTERPRETATION AND ADMINISTRATION

3.    Medical Plan Provisions

4.    Medical Benefit

 

SECTION III: MEDICAL CLAIMS EXAMINING GUIDELINES AND PROCEDURES

5.    Medical Claims Administration

6.    Physician's, Clinical, and Hospital Services Claims

7.    Surgery and Anesthesia Claims

8.    Medicare and Medicaid

9.    Workers' Compensation

10.  Managed Care Claims

 

SECTION IV: MANAGEMENT OF CLAIMS EXAMINING

11.  Claims Examination

12.  Processing Non-Medicare Claims

13.  Processing Medicare Claims

14.  Processing Workers' Compensation Claims

 

SECTION V: APPENDICES