Exercises for Coding and Reimbursement / Edition 2

Exercises for Coding and Reimbursement / Edition 2

by ICDC Publishing Inc.

View All Available Formats & Editions

ISBN-10: 0131722530

ISBN-13: 9780131722538

Pub. Date: 11/10/2006

Publisher: Prentice Hall

Welcome to the exciting world of medical billing and health claims examining. This book is designed to help the student gain the real life experience of a medical biller and health claims examiner through a simulated work practice.The straightforward easy-to-understand writing style presents information clearly and concisely. Patient and provider names, diagnoses,


Welcome to the exciting world of medical billing and health claims examining. This book is designed to help the student gain the real life experience of a medical biller and health claims examiner through a simulated work practice.The straightforward easy-to-understand writing style presents information clearly and concisely. Patient and provider names, diagnoses, exercises and examples in this training material have been designed to incorporate a light-hearted humorous context. We have found that humorous writing improves the ability to comprehend and retain information.

Product Details

Prentice Hall
Publication date:
Edition description:
New Edition
Product dimensions:
8.50(w) x 10.90(h) x 0.90(d)

Table of Contents

Chapter 1. Introduction


Getting Started

Entering A Claim “Into A Computer System”

Medical Billing

Health Claims Examining

Let’s Begin Medical Billing

Medical Billing Guidelines

Setting Up Your “Office”

Deposit Envelope

Patient Files

Fastener 1

Fastener 2

Fastener 3, 4, and 5

Last Fastener

Training Tip

Let’s Begin Health Claims Examining

Health Claims Examining Guidelines

Setting Up Your “Desk”

Family Files

Fastener 1—Entire Family

Fastener 2—Insured

Fastener 3—Spouse

Fastener 4, 5, and 6—Dependent Data

Training Tip

Chapter 2. Physicians’ Services

Medical Billing Exercise 2—1

Family Data Table (Espinosa Family) (Document 1)

Family Data Table (Smith Family) (Document 2)

Family Data Table (Parker Family) (Document 3)

Medical Billing Exercise 2—2

Medical Billing Exercise 2—3

Medical Billing Exercise 2—4

Medical Billing Exercise 2—5

Beginning Financials (Espinosa Family) (Document 4)

Encounter Form (Evelyn Espinosa) (Document 5)

Encounter Form (Elisa Espinosa) (Document 6)

Encounter Form (Eva Espinosa) (Document 7)

Encounter Form (Evan Espinosa) (Document 8)

Encounter Form (Evan Espinosa) (Document 9)

Beginning Financials (Smith Family) (Document 10)

Encounter Form (Sharon Smith) (Document 11)

Encounter Form (Steve Smith) (Document 12)

Encounter Form (Sharon Smith) (Document 13)

Encounter Form (Sam Smith) (Document 14)

Encounter Form (Sharon Smith) (Document 15)

Beginning Financials (Parker Family) (Document 16)

Encounter Form (Patricia Parker) (Document 17)

Encounter Form (Peter Parker) (Document 18)

Encounter Form (Pauline Parker) (Document 19)

Encounter Form (Peter Parker) (Document 20)

Encounter Form (Pauline Parker) (Document 21)

Health Claims Examining Exercise 2—A

Health Claims Examining Exercise 2—B

Chapter 3. Diagnostic X-Ray and Laboratory Services

Medical Billing Exercise 3—1

Family Data Table (Green Family) (Document 22)

Family Data Table (Francisco Family) (Document 23)

Family Data Table (Hernandez Family) (Document 24)

Medical Billing Exercise 3—2

Medical Billing Exercise 3—3

Medical Billing Exercise 3—4

Medical Billing Exercise 3—5

Beginning Financials (Green Family) (Document 25)

Encounter Form (George Green) (Document 26)

Encounter Form (Greg Green) (Document 27)

Encounter Form (Gina Green) (Document 28)

Encounter Form (Greta Green) (Document 29)

Encounter Form (George Green) (Document 30)

Beginning Financials (Francisco Family) (Document 31)

Encounter Form (Frank Francisco) (Document 32)

Encounter Form (Felicia Francisco) (Document 33)

Encounter Form (Fred Francisco) (Document 34)

Encounter Form (Felicia Francisco) (Document 35)

Encounter Form (Freda Francisco) (Document 36)

Beginning Financials (Hernandez Family) (Document 37)

Encounter Form (Hector Hernandez) (Document 38)

Encounter Form (Hortencia Hernandez) (Document 39)

Encounter Form (Hector Hernandez) (Document 40)

Encounter Form (Hortencia Hernandez) (Document 41)

Encounter Form (Henriquez Hernandez) (Document 42)

Health Claims Examining Exercise 3—A

Health Claims Examining Exercise 3—B

Chapter 4. Surgery Services

Medical Billing Exercise 4—1

Family Data Table (Gates Family) (Document 43)

Family Data Table (Butler Family) (Document 44)

Family Data Table (Smith Family) (Document 45)

Medical Billing Exercise 4—2

Medical Billing Exercise 4—3

Medical Billing Exercise 4—4

Medical Billing Exercise 4—5

Beginning Financials (Gates Family) (Document 46)

Encounter Form (Guadalupe Gates) (Document 47)

Encounter Form (Guadalupe Gates) (Document 48)

Encounter Form (Gloria Gates) (Document 49)

Encounter Form (Guillermo Gates) (Document 50)

Encounter Form (Guillermo Gates) (Document 51)

Beginning Financials (Butler Family) (Document 52)

Encounter Form (Barbara Butler) (Document 53)

Encounter Form (Branford Butler) (Document 54)

Encounter Form (Brielle Butler) (Document 55)

Encounter Form Brielle Butler) (Document 56)

Encounter Form (Branford Butler) (Document 57)

Beginning Financials (Smith Family) (Document 58)

Encounter Form (Sheryl Smith) (Document 59)

Encounter Form (Shane Smith) (Document 60)

Encounter Form (Shawn Smith) (Document 61)

Encounter Form (Sheryl Smith) (Document 62)

Encounter Form (Shane Smith) (Document 63)

Health Claims Examining Exercise 4—A

Health Claims Examining Exercise 4—B

Chapter 5. Multiple Surgery Services

Medical Billing Exercise 5—1

Family Data Table (Thompson Family) (Document 64)

Family Data Table (Martin Family) (Document 65)

Medical Billing Exercise 5—2

Medical Billing Exercise 5—3

Medical Billing Exercise 5—4

Medical Billing Exercise 5—5

Beginning Financials (Thompson Family) (Document 66)

Encounter Form (Tony Thompson) (Document 67)

Encounter Form (Terry Thompson) (Document 68)

Encounter Form (Traci Thompson) (Document 69)

Encounter Form (Tony Thompson) (Document 70)

Encounter Form (Tina Thompson) (Document 71)

Beginning Financials (Martin Family) (Document 72)

Encounter Form (Mark Martin) (Document 73)

Encounter Form (Melissa Martin) (Document 74)

Encounter Form (Maria Martin) (Document 75)

Encounter Form (Melody Martin) (Document 76)

Encounter Forms (Maria Martin) (Document 77)

Health Claims Examining Exercise 5—A

Health Claims Examining Exercise 5—B

Chapter 6. Assistant Surgery Services

Medical Billing Exercise 6—1

Family Data Table (Dodson Family) (Document 78)

Family Data Table (Westin Family) (Document 79)

Family Data Table (Smith Family) (Document 80)

Medical Billing Exercise 6—2

Medical Billing Exercise 6—3

Medical Billing Exercise 6—4

Medical Billing Exercise 6—5

Beginning Financials (Dodson Family) (Document 81)

Encounter Form (Doris Dodson) (Document 82)

Encounter Form (Debbie Dodson) (Document 83)

Encounter Form (Daniel Dodson) (Document 84)

Encounter Form (Deedee Dodson) (Document 85)

Encounter Form (Daniel Dodson) (Document 86)

Beginning Financials (Westin Family) (Document 87)

Encounter Form (William Westin) (Document 88)

Encounter Form (Wilma Westin) (Document 89)

Encounter Form (Wilma Westin) (Document 90)

Encounter Form (Wendy Westin) (Document 91)

Encounter Form (William Westin) (Document 92)

Beginning Financials (Smith Family) (Document 93)

Encounter Form (Sherman Smith) (Document 94)

Encounter Form (Sherry Smith) (Document 95)

Encounter Form (Sherry Smith) (Document 96)

Encounter Form (Sean Smith) (Document 97)

Encounter Form (Sherman Smith) (Document 98)

Health Claims Examining Exercise 6—A

Health Claims Examining Exercise 6—B

Chapter 7. Anesthesia Services

Medical Billing Exercise 7—1

Family Data Table (Norton Family) (Document 99)

Medical Billing Exercise 7—2

Medical Billing Exercise 7—3

Medical Billing Exercise 7—4

Medical Billing Exercise 7—5

Beginning Financials (Norton Family) (Document 100)

Encounter Form (Ned Norton) (Document 101)

Encounter Form (Nancy Norton) (Document 102)

Encounter Form (Neil Norton) (Document 103)

Encounter Form (Nancy Norton) (Document 104)

Encounter Form (Nina Norton) (Document 105)

Beginning Financials (Westin Family) (Document 106)

Encounter Form (Wendy Westin) (Document 107)

Encounter Form (Wally Westin) (Document 108)

Encounter Form (William Westin) (Document 109)

Encounter Form (Wendy Westin) (Document 110)

Encounter Form (Wilma Westin) (Document 111)

Health Claims Examining Exercise 7—A

Health Claims Examining Exercise 7—B

Chapter 8. Hospital Services

Medical Billing Exercise 8—1

Family Data Table (Gonzales Family) (Document 112)

Family Data Table (Levine Family) (Document 113)

Family Data Table (Ingles Family) (Document 114)

Family Data Table (Jennings Family) (Document 115)

Family Data Table (Fury Family) (Document 116)

Medical Billing Exercise 8—2

Medical Billing Exercise 8—3

Medical Billing Exercise 8—4

Medical Billing Exercise 8—5

Beginning Financials (Gonzales Family) (Document 117)

Hospital Admission Form (Gary Gonzales) (Document 118)

Hospital Itemization Documents (Document 118)

Hospital Admission Form (Genara Gonzales) (Document 119)

Hospital Itemization Documents (Document 119)

Hospital Admission Form (Ginnie Gonzales) (Document 120)

Hospital Itemization Document (Document 120)

Hospital Admission Form (Gary Gonzales, Jr.) (Document 121)

Hospital Itemization Document (Document 121)

Hospital Admission Form (Grace Gonzales) (Document 122)

Hospital Itemization Document (Document 122)

Beginning Financials (Levine Family) (Document 123)

Hospital Admission Form (Larry Levine) (Document 124)

Hospital Itemization Document (Document 124)

Hospital Admission Form (Lannie Levine) (Document 125)

Hospital Itemization Documents (Document 125)

Hospital Admission Form (Lloyd Levine) (Document 126)

Hospital Itemization Document (Document 126)

Hospital Admission Form (Lisa Levine) (Document 127)

Hospital Itemization Documents (Document 127)

Hospital Admission Form (Lila Levine) (Document 128)

Hospital Itemization Document (Document 128)

Beginning Financials (Ingles Family) (Document 129)

Hospital Admission Form (Inez Ingles) (Document 130)

Hospital Itemization Documents (Document 130)

Hospital Admission Form (Irving Ingles) (Document 131)

Hospital Itemization Document (Document 131)

Hospital Admission Form (Irma Ingles) (Document 132)

Hospital Itemization Document (Document 132)

Hospital Admission Form (Inez Ingles) (Document 133)

Hospital Itemization Document (Document 133)

Hospital Admission Form (Ilene Ingles) (Document 134)

Hospital Itemization Document (Document 134)

Beginning Financials (Jennings Family) (Document 135)

Hospital Admission Form (Jacqueline Jennings) (Document 136)

Hospital Itemization Document (Document 136)

Hospital Admission Form (Julia Jennings) (Document 137)

Hospital Itemization Documents (Document 137)

Hospital Admission Form (Jack Jennings) (Document 138)

Hospital Itemization Document (Document 138)

Hospital Admission Form (Jennifer Jennings) (Document 139)

Hospital Itemization Documents (Document 139)

Hospital Admission Form (Baby Boy Jennings) (Document 140)

Hospital Itemization Documents (Document 140)

Hospital Admission Form (Janet Jennings) (Document 141)

Hospital Itemization Documents (Document 141)

Beginning Financials (Fury Family) (Document 142)

Hospital Admission Form (Fay Fury) (Document 143)

Hospital Itemization Documents (Document 143)

Utilization Review Certification (Document 143)

Hospital Admission Form (Fay Fury) (Document 144)

Hospital Itemization Documents (Document 144)

Utilization Review Certification (Document 144)

Hospital Admission Form (Fred Fury) (Document 145)

Hospital Itemization Documents (Document 145)

Utilization Review Certification (Document 145)

Hospital Admission Form (Fern Fury) (Document 146)

Hospital Itemization Documents (Document 146)

Utilization Review Certification (Document 146)

Hospital Admission Form (Forrest Fury) (Document 147)

Hospital Itemization Documents (Document 147)

Utilization Review Certification (Document 147)

Health Claims Examining Exercise 8—A

Health Claims Examining Exercise 8—B

Chapter 9. Coordination of Benefits

Medical Billing Exercise 9—1

Family Data Table (Brown Family) (Document 148)

Family Data Table (Allred Family) (Document 149)

Family Data Table (Innman Family) (Document 150)

Medical Billing Exercise 9—2

Medical Billing Exercise 9—3

Medical Billing Exercise 9—4

Medical Billing Exercise 9—5

Beginning Financials (Brown Family) (Document 151)

Encounter Form (Bobby Brown) (Document 152)

Explanation of Medical Benefits (Document 152)

Encounter Form (Bernice Brown) (Document 153)

Explanation of Medical Benefits (Document 153)

Encounter Form (Bernice Brown) (Document 154)

Explanation of Medical Benefits (Document 154)

Patient Claim Form (Bernice Brown) (Document 155)

Explanation of Medical Benefits (Document 155)

Encounter Form (Brenda Brown) (Document 156)

Explanation of Medical Benefits (Document 156)

Hospital Admission Form (Bobby Brown) (Document 157)

Hospital Itemization Document (Document 157)

Explanation of Medical Benefits (Document 157)

Encounter Form (Bobby Brown) (Document 158)

Explanation of Medical Benefits (Document 158)

Explanation of Medical Benefits (Document 158)

Beginning Financials (Allred Family) (Document 159)

Encounter Form (Allison Allred) (Document 160)

Explanation of Medical Benefits (Document 160)

Encounter Form (Allison Allred) (Document 161)

Explanation of Medical Benefits (Document 161)

Hospital Admission Form (Allen Allred) (Document 162)

Hospital Itemization Document (Document 162)

Explanation of Medical Benefits (Document 162)

Encounter Form (Ann Allred) (Document 163)

Explanation of Medical Benefits (Document 163)

Hospital Admission Form (Allison Allred) (Document 164)

Hospital Itemization Document (Document 164)

Explanation of Medical Benefits (Document 164)

Beginning Financials (Innman Family) (Document 165)

Hospital Admission Form (Ingrid Innman) (Document 166)

Hospital Itemization Document (Document 166)

Explanation of Medical Benefits (Document 166)

Encounter Form (Ingrid Innman) (Document 167)

Explanation of Medical Benefits (Document 167)

Patient Claim Form (Ingrid Innman) (Document 168)

Explanation of Medical Benefits (Document 168)

Encounter Form (Ian Innman) (Document 169)

Explanation of Medical Benefits (Document 169)

Hospital Admission Form (Ian Innman) (Document 170)

Hospital Itemization Document (Document 170)

Explanation of Medical Benefits (Document 170)

Health Claims Examining Exercise 9—A

Health Claims Examining Exercise 9—B

Chapter 10. Medicare and Medicaid Services

Medical Billing Exercise 10—1

Family Data Table (Vaughn Family) (Document 171)

Family Data Table (Conners Family) (Document 172)

Family Data Table (Hanaka Family) (Document 173)

Medical Billing Exercise 10—2

Medical Billing Exercise 10—3

Medical Billing Exercise 10—4

Medical Billing Exercise 10—5

Medical Billing Exercise 10—6

Medical Billing Exercise 10—7

Beginning Financials (Vaughn Family) (Document 174)

Encounter Form (Vernon Vaughn) (Document 175)

Encounter Form (Vernon Vaughn) (Document 176)

Encounter Form (Vernon Vaughn) (Document 177)

Encounter Form (Vicki Vaughn) (Document 178)

Encounter Form (Vicki Vaughn) (Document 179)

Beginning Financials (Conners Family) (Document 180)

Encounter Form (Chris Conners) (Document 181)

Encounter Form (Clara Conners) (Document 182)

Encounter Form (Clara Conners) (Document 183)

Hospital Admission Form (Chris Conners) (Document 184)

Hospital Itemization Document (Document 184)

Hospital Admission Form (Chris Conners) (Document 185)

Hospital Itemization Document (Document 185)

Beginning Financials (Hanaka Family) (Document 186)

Encounter Form (Hiro Hanaka) (Document 187)

Encounter Form (Hiro Hanaka) (Document 188)

Encounter Form (Holly Hanaka) (Document 189)

Hospital Admission Form (Holly Hanaka) (Document 190)

Hospital Itemization Document (Document 190)

Encounter Form (Holly Hanaka) (Document 191)

Health Claims Examining Exercise 10—A

Health Claims Examining Exercise 10—B

Medicare Remittance Notice (Document 192)

Medicare Remittance Notice (Document 192)

Chapter 11. Miscellaneous Services

Medical Billing Exercise 11—1

Family Data Table (Rubble Family) (Document 193)

Family Data Table (Minnetoma Family) (Document 194)

Family Data Table (Talawan Family) (Document 195)

Medical Billing Exercise 11—2

Medical Billing Exercise 11—3

Medical Billing Exercise 11—4

Medical Billing Exercise 11—5

Beginning Financials (Rubble Family) (Document 196)

Encounter Form (Raisa Rubble) (Document 197)

Encounter Form (Raisa Rubble) (Document 198)

Encounter Form (Renee Rubble) (Document 199)

Encounter Form (Royal Rubble) (Document 200)

Encounter Form (Renee Rubble) (Document 201)

Beginning Financials (Minnetoma Family) (Document 202)

Encounter Form (Monty Minnetoma) (Document 203)

Encounter Form (Monty Minnetoma) (Document 204)

Encounter Form (Melanie Minnetoma) (Document 205)

Encounter Form (Morey Minnetoma) (Document 206)

Encounter Form (Melanie Minnetoma) (Document 207)

Beginning Financials (Talawan Family) (Document 208)

Encounter Form (Taura Talawan) (Document 209)

Encounter Form (Tabari Talawan) (Document 210)

Encounter Form (Tabari Talawan) (Document 211)

Encounter Form (Taura Talawan) (Documents 212)

Encounter Form (TiRon Talawan) (Documents 213)

Health Claims Examining Exercise 11—A

Health Claims Examining Exercise 11—B

Chapter 12. Forms

Patient Information Sheet

Ledger Card/Statement of Account

Insurance Coverage Form

Patient Receipt

Deposit Slip/Ticket

Insurance Claims Register

Insurance Tracer

Charge Slip

Treatment Authorization Request

Stationery (Any Billing Services)

Request for Additional Information Form

Payment Worksheet

Family Benefit Tracking Sheet

Coordination of Benefits Calculation Worksheet

Stationery (Any Insurance Carrier, Inc.)

Request for Additional Information Forms

Chapter 13. Contracts, and Other Claims Information

Contract 1 — ABC Corporation/ Winter Insurance Company

Contract 2 — Ninja Enterprises/ Rover Insurers, Inc

Contract 3 — XYZ Corporation/ Ball Insurance Carriers

UCR Conversion Factor Report

Relative Value Study

Assistant Surgeon ProcedureList

Network Provider List

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