Master the complexities of health insurance with this easy-to-understand guide! Health Insurance Today: A Practical Approach, 7th Edition provides a solid foundation in basics such as the types and sources of health insurance, the submission of claims, and the ethical and legal issues surrounding insurance. It follows the claims process from billing and coding to reimbursement procedures, with realistic practice on the Evolve website. This edition adds coverage of the latest advances and issues in health insurance, including EHRs, Medicare, and other types of carriers. Written by Medical Assisting educators Janet Beik and Julie Pepper, this resource prepares you for a successful career as a health insurance professional.
1. Cover image - p. i 2. Title page - p. ii 3. Table of Contents - p. iii 4. Copyright - p. iii 5. Reviewers - p. iii 6. Preface - p. iv 7. A word about HIPAA - p. vii 8. About the authors - p. viii 9. Acknowledgments - p. ix 10. List of Tables - p. xi 11. List of Illustrations - p. x 12. UNIT I. Building a Foundation - p. x 13. 1. The origins of health insurance - p. 1 14. 2. Tools of the trade: A career as a health insurance professional - p. 14 15. 3. The legal and ethical side of health insurance - p. 26 16. 4. Healthcare reform: Coverage types and sources - p. 46 17. 5. The patient and the billing process - p. 66 18. UNIT II. Health Insurance Basics - p. 89 19. 6. Claim submission methods - p. 90 20. 7. Claims management - p. 113 21. 8. Reimbursement models - p. 133 22. 9. The changing face of managed care - p. 152 23. 10. Understanding medicaid - p. 174 24. 11. Conquering Medicare’s challenges - p. 203 25. The Medicare Program - p. 205 26. The effects of the ACA on Medicare coverage - p. 215 27. Medicare combination coverages - p. 216 28. Medicare and managed care - p. 220 29. Preparing for the Medicare patient - p. 222 30. Medicare billing - p. 226 31. Filing Medicare claims - p. 227 32. Using the CMS-1500 form for Medicare claims - p. 231 33. Medicare Summary Notice and remittance advice - p. 235 34. Medicare audits and appeals - p. 241 35. Quality review studies - p. 244 36. Medicare billing fraud - p. 246 37. Clinical Laboratory Improvement Amendments Program - p. 246 38. Summary checkpoints - p. 246 39. Chapter review questions - p. 248 40. Websites to explore - p. 249 41. 12. Military carriers - p. 250 42. 13. Miscellaneous carriers - p. 285 43. UNIT III. Cracking The Codes - p. 312 44. 14. Diagnostic coding - p. 313 45. 15. Procedural, evaluation and management, and HCPCS coding - p. 342 46. UNIT IV. Advanced Application - p. 366 47. 16. The role of computers in health insurance - p. 367 48. 17. Reimbursement procedures: Getting paid - p. 382 49. 18. Hospital billing and the UB-04 - p. 404 50. Appendix A: Sample blank CMS 1500 (02/12) - p. 441 51. Appendix B: CMS 1500 claim forms and completion instructions - p. 442 52. Appendix C: UB 04 claim forms and completion instructions - p. 462 53. Glossary - p. 466 54. Resources - p. 484 55. Index - p. 486
Master the complexities of health insurance with this easy-to-understand guide! Health Insurance Today: A Practical Approach, 7th Edition provides a solid foundation in basics such as the types and sources of health insurance, the submission of claims, and the ethical and legal issues surrounding insurance. It follows the claims process from billing and coding to reimbursement procedures, with realistic practice on the Evolve website. This edition adds coverage of the latest advances and issues in health insurance, including EHRs, Medicare, and other types of carriers. Written by Medical Assisting educators Janet Beik and Julie Pepper, this resource prepares you for a successful career as a health insurance professional.
1. Cover image - p. i 2. Title page - p. ii 3. Table of Contents - p. iii 4. Copyright - p. iii 5. Reviewers - p. iii 6. Preface - p. iv 7. A word about HIPAA - p. vii 8. About the authors - p. viii 9. Acknowledgments - p. ix 10. List of Tables - p. xi 11. List of Illustrations - p. x 12. UNIT I. Building a Foundation - p. x 13. 1. The origins of health insurance - p. 1 14. 2. Tools of the trade: A career as a health insurance professional - p. 14 15. 3. The legal and ethical side of health insurance - p. 26 16. 4. Healthcare reform: Coverage types and sources - p. 46 17. 5. The patient and the billing process - p. 66 18. UNIT II. Health Insurance Basics - p. 89 19. 6. Claim submission methods - p. 90 20. 7. Claims management - p. 113 21. 8. Reimbursement models - p. 133 22. 9. The changing face of managed care - p. 152 23. 10. Understanding medicaid - p. 174 24. 11. Conquering Medicare’s challenges - p. 203 25. The Medicare Program - p. 205 26. The effects of the ACA on Medicare coverage - p. 215 27. Medicare combination coverages - p. 216 28. Medicare and managed care - p. 220 29. Preparing for the Medicare patient - p. 222 30. Medicare billing - p. 226 31. Filing Medicare claims - p. 227 32. Using the CMS-1500 form for Medicare claims - p. 231 33. Medicare Summary Notice and remittance advice - p. 235 34. Medicare audits and appeals - p. 241 35. Quality review studies - p. 244 36. Medicare billing fraud - p. 246 37. Clinical Laboratory Improvement Amendments Program - p. 246 38. Summary checkpoints - p. 246 39. Chapter review questions - p. 248 40. Websites to explore - p. 249 41. 12. Military carriers - p. 250 42. 13. Miscellaneous carriers - p. 285 43. UNIT III. Cracking The Codes - p. 312 44. 14. Diagnostic coding - p. 313 45. 15. Procedural, evaluation and management, and HCPCS coding - p. 342 46. UNIT IV. Advanced Application - p. 366 47. 16. The role of computers in health insurance - p. 367 48. 17. Reimbursement procedures: Getting paid - p. 382 49. 18. Hospital billing and the UB-04 - p. 404 50. Appendix A: Sample blank CMS 1500 (02/12) - p. 441 51. Appendix B: CMS 1500 claim forms and completion instructions - p. 442 52. Appendix C: UB 04 claim forms and completion instructions - p. 462 53. Glossary - p. 466 54. Resources - p. 484 55. Index - p. 486
