This combination textbook and workbook, explains each phase of the medical claim cycle, from the time the patient calls for an appointment until the financial transaction for the encounter is completed. Coverage includes types of insurance payers, basic coding and billing rules, and standard requirements for outpatient billing using the CMS-1500 claim form. It also emphasizes legal aspects related to each level of the medical claim cycle and the importance of the medical office employee, showing their responsibility for and impact on successful reimbursement.
1. Cover image - p. 1 2. Title page - p. 2 3. Table of Contents - p. 3 4. EDITORIAL REVIEW BOARD - p. 4 5. PREFACE - p. 5 6. ACKNOWLEDGMENTS - p. 9 7. Chapter 1: LEARNING TO SPEAK THE LANGUAGE - p. 10 8. Chapter 2: YOU’RE PART OF A TEAM - p. 29 9. Chapter 3: HOW THE MEDICAL CLAIM CYCLE WORKS - p. 45 10. Chapter 4: CMS-1500 CLAIM FORM - p. 62 11. Chapter 5: BASIC PRINCIPLES OF DIAGNOSIS CODING - p. 85 12. Chapter 6: BASIC PRINCIPLES FOR EVALUATION AND MANAGEMENT (E/M) SERVICES - p. 107 13. Chapter 7: BASIC PRINCIPLES OF PROCEDURE CODING - p. 131 14. Chapter 8: PRIVATE INDEMNITY AND MANAGED CARE MEDICAL PLANS - p. 152 15. Chapter 9: OTHER INSURANCE PLANS WITH MEDICAL COVERAGE AND DISABILITY PLANS - p. 166 16. Chapter 10: MEDICARE - p. 173 17. Chapter 11: OTHER GOVERNMENT MEDICAL PLANS - p. 184 18. Chapter 12: HOSPITAL/FACILITY BILLING RULES - p. 197 19. Chapter 13: REIMBURSEMENT SUCCESS - p. 218 20. Chapter 14: DEVELOPING CRITICAL THINKING SKILLS: ANALYZING PROBLEMS AND MAKING DECISIONS - p. 234 21. Appendixes - p. 255 22. APPENDIX A: 1997 Examination Tables - p. 256 23. APPENDIX B: Directory of State Contacts - p. 263 24. APPENDIX C: Lake Eola Family Practice Associates - p. 274 25. APPENDIX D: Quick Guide to HIPAA for the Physician’s Office - p. 275 26. GLOSSARY - p. 287 27. INDEX - p. 298
This combination textbook and workbook, explains each phase of the medical claim cycle, from the time the patient calls for an appointment until the financial transaction for the encounter is completed. Coverage includes types of insurance payers, basic coding and billing rules, and standard requirements for outpatient billing using the CMS-1500 claim form. It also emphasizes legal aspects related to each level of the medical claim cycle and the importance of the medical office employee, showing their responsibility for and impact on successful reimbursement.
1. Cover image - p. 1 2. Title page - p. 2 3. Table of Contents - p. 3 4. EDITORIAL REVIEW BOARD - p. 4 5. PREFACE - p. 5 6. ACKNOWLEDGMENTS - p. 9 7. Chapter 1: LEARNING TO SPEAK THE LANGUAGE - p. 10 8. Chapter 2: YOU’RE PART OF A TEAM - p. 29 9. Chapter 3: HOW THE MEDICAL CLAIM CYCLE WORKS - p. 45 10. Chapter 4: CMS-1500 CLAIM FORM - p. 62 11. Chapter 5: BASIC PRINCIPLES OF DIAGNOSIS CODING - p. 85 12. Chapter 6: BASIC PRINCIPLES FOR EVALUATION AND MANAGEMENT (E/M) SERVICES - p. 107 13. Chapter 7: BASIC PRINCIPLES OF PROCEDURE CODING - p. 131 14. Chapter 8: PRIVATE INDEMNITY AND MANAGED CARE MEDICAL PLANS - p. 152 15. Chapter 9: OTHER INSURANCE PLANS WITH MEDICAL COVERAGE AND DISABILITY PLANS - p. 166 16. Chapter 10: MEDICARE - p. 173 17. Chapter 11: OTHER GOVERNMENT MEDICAL PLANS - p. 184 18. Chapter 12: HOSPITAL/FACILITY BILLING RULES - p. 197 19. Chapter 13: REIMBURSEMENT SUCCESS - p. 218 20. Chapter 14: DEVELOPING CRITICAL THINKING SKILLS: ANALYZING PROBLEMS AND MAKING DECISIONS - p. 234 21. Appendixes - p. 255 22. APPENDIX A: 1997 Examination Tables - p. 256 23. APPENDIX B: Directory of State Contacts - p. 263 24. APPENDIX C: Lake Eola Family Practice Associates - p. 274 25. APPENDIX D: Quick Guide to HIPAA for the Physician’s Office - p. 275 26. GLOSSARY - p. 287 27. INDEX - p. 298
