Unit One: Career Role and Responsibilities 1. Role of an Insurance Billing Specialist 2. Privacy, Security and HIPAA 3. Compliance, Fraud and Abuse
Unit Two: Introduction to the Revenue Cycle Process 4. Basics of Health Insurance 5. The Blue Plans, Private Insurance, and Managed Care Plans 6. Medicare 7. Medicaid and other State Programs 8. Tricare and Veterans' Health Care 9. Workers' Compensation 10. Disability Income Insurance and Disability Benefit Programs
Unit Three: Documentation and Coding 11. Medical Documentation and the Electronic Health Record 12. Diagnostic Coding 13. Procedural Coding
Unit Four: Claims Submission in The Medical Office 14. The Paper Claim CMS-1500 15. The Electronic Claim
Unit Five: The Claim Follow Up and Payment Process 16. Receiving Payments and Insurance Problem Solving 17. Office and Insurance Collection Strategies
Unit Six: Healthcare Facility Billing 18. Ambulatory Surgical Center 19. Hospital Outpatient and Inpatient Billing Unit Seven: Employment 20. Seeking a Job and Attaining Professional Advancement
Gain real-world practice in insurance billing and coding! Corresponding to the chapters in Fordney's Medical Insurance, 15th Edition, this workbook provides realistic, hands-on exercises that help you apply concepts and develop critical thinking skills. Study tools include chapter overviews, key terms, chapter review exercises, and case study assignments. Additionally, this workbook helps you develop a better understanding of the differences among the insurance programs when completing and electronically transmitting the 837 P or the CMS-1500 paper claim.
- Key terms and abbreviations lists at the beginning of each chapter provide a quick reference to the health insurance terminology you need to know.
- Performance objectives make learning easy by highlighting what you need to accomplish in each chapter.
- Study outlines focus review by listing key points for each chapter.
- Self-study exercises - including matching, true/false, multiple-choice, mix and match, and fill-in-the-blank questions - help you practice important concepts.
- Critical Thinking Assignments in the form of short, real-world vignettes prepare you for working in a real medical office and allow you to apply theory learned from the textbook.
New to this Edition
- NEW! Expanded coverage of inpatient insurance billing, including ICD-10 coding and CMS provides you with the foundation and skills needed to work in the physician office, outpatient, and inpatient setting.
- NEW! Ambulatory Surgical Center (ASC) billing chapter provides you with the foundation and skills needed to work in this outpatient setting.
- NEW! Updated information on general compliance issues, HIPAA, Affordable Care Act and coding reflects changes to the main text.