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. Health Insurance Today - p. IFC 2. Cover Image - p. IFC 3. Ifc - p. IFC 4. Title Page - p. i 5. Copyright - p. ii 6. Table of Contents - p. ii 7. Reviewers - p. iii 8. Preface - p. iv 9. A word about HIPAA - p. vii 10. About the authors - p. viii 11. Acknowledgments - p. ix 12. 1 The origins of health insurance - p. 1 13. 2 Tools of the trade: A career as a health insurance professional - p. 14 14. 3 The legal and ethical side of health insurance - p. 26 15. 4 Healthcare reform: Coverage types and sources - p. 46 16. 5 The patient and the billing process - p. 66 17. 6 Claim submission methods - p. 90 18. 7 Claims management - p. 113 19. 8 Reimbursement models - p. 133 20. 9 The changing face of managed care - p. 152 21. 10 Understanding medicaid - p. 174 22. 11 Conquering Medicare’s challenges - p. 203 23. Chapter Outline - p. 203 24. Chapter Objectives - p. 204 25. Chapter Terms - p. 204 26. The Medicare Program - p. 205 27. The Effects of the ACA on Medicare Coverage - p. 215 28. Medicare Combination Coverages - p. 216 29. Medicare and Managed Care - p. 220 30. Preparing for the Medicare Patient - p. 222 31. Medicare Billing - p. 226 32. Filing Medicare Claims - p. 228 33. Using the CMS-1500 Form for Medicare Claims - p. 231 34. Medicare Summary Notice and Remittance Advice - p. 235 35. Medicare Audits and Appeals - p. 241 36. Quality Review Studies - p. 244 37. Medicare Billing Fraud - p. 246 38. Clinical Laboratory Improvement Amendments Program - p. 246 39. Summary Checkpoints - p. 246 40. Chapter Review Questions - p. 248 41. Websites to Explore - p. 249 42. 12 Military carriers - p. 250 43. 13 Miscellaneous carriers - p. 285 44. 14 Diagnostic coding - p. 313 45. 15 Procedural, evaluation and management, and HCPCS coding - p. 342 46. 16 The role of computers in health insurance - p. 367 47. 17 Reimbursement procedures: Getting paid - p. 382 48. 18 Hospital billing and the UB-04 - p. 404 49. appendix A Sample blank CMS-1500 (02/12) - p. 441 50. appendix B CMS-1500 claim forms and completion instructions - p. 442 51. appendix C UB-04 claim forms and completion instructions - p. 462 52. Glossary - p. 466 53. Resources - p. 484 54. 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. Health Insurance Today - p. IFC 2. Cover Image - p. IFC 3. Ifc - p. IFC 4. Title Page - p. i 5. Copyright - p. ii 6. Table of Contents - p. ii 7. Reviewers - p. iii 8. Preface - p. iv 9. A word about HIPAA - p. vii 10. About the authors - p. viii 11. Acknowledgments - p. ix 12. 1 The origins of health insurance - p. 1 13. 2 Tools of the trade: A career as a health insurance professional - p. 14 14. 3 The legal and ethical side of health insurance - p. 26 15. 4 Healthcare reform: Coverage types and sources - p. 46 16. 5 The patient and the billing process - p. 66 17. 6 Claim submission methods - p. 90 18. 7 Claims management - p. 113 19. 8 Reimbursement models - p. 133 20. 9 The changing face of managed care - p. 152 21. 10 Understanding medicaid - p. 174 22. 11 Conquering Medicare’s challenges - p. 203 23. Chapter Outline - p. 203 24. Chapter Objectives - p. 204 25. Chapter Terms - p. 204 26. The Medicare Program - p. 205 27. The Effects of the ACA on Medicare Coverage - p. 215 28. Medicare Combination Coverages - p. 216 29. Medicare and Managed Care - p. 220 30. Preparing for the Medicare Patient - p. 222 31. Medicare Billing - p. 226 32. Filing Medicare Claims - p. 228 33. Using the CMS-1500 Form for Medicare Claims - p. 231 34. Medicare Summary Notice and Remittance Advice - p. 235 35. Medicare Audits and Appeals - p. 241 36. Quality Review Studies - p. 244 37. Medicare Billing Fraud - p. 246 38. Clinical Laboratory Improvement Amendments Program - p. 246 39. Summary Checkpoints - p. 246 40. Chapter Review Questions - p. 248 41. Websites to Explore - p. 249 42. 12 Military carriers - p. 250 43. 13 Miscellaneous carriers - p. 285 44. 14 Diagnostic coding - p. 313 45. 15 Procedural, evaluation and management, and HCPCS coding - p. 342 46. 16 The role of computers in health insurance - p. 367 47. 17 Reimbursement procedures: Getting paid - p. 382 48. 18 Hospital billing and the UB-04 - p. 404 49. appendix A Sample blank CMS-1500 (02/12) - p. 441 50. appendix B CMS-1500 claim forms and completion instructions - p. 442 51. appendix C UB-04 claim forms and completion instructions - p. 462 52. Glossary - p. 466 53. Resources - p. 484 54. Index - p. 486
