Glencoe From Patient to Payment: Insurance Procedures for the Medical Office / Edition 2

Glencoe From Patient to Payment: Insurance Procedures for the Medical Office / Edition 2

by Cynthia Newby, Rhonda Collins
     
 

ISBN-10: 0028019881

ISBN-13: 9780028019888

Pub. Date: 11/28/1997

Publisher: McGraw-Hill Higher Education

This practical text-workbook introduces students step-by-step to the basic functions related to processing medical insurance claims and provides extensive practice with the universal medical insurance claim form, the HCFA-1500. New chapters include dental insurance and electronic media claims. Manual and computerized HCFA form tutorial simulations provide real-world

Overview

This practical text-workbook introduces students step-by-step to the basic functions related to processing medical insurance claims and provides extensive practice with the universal medical insurance claim form, the HCFA-1500. New chapters include dental insurance and electronic media claims. Manual and computerized HCFA form tutorial simulations provide real-world experience.

Product Details

ISBN-13:
9780028019888
Publisher:
McGraw-Hill Higher Education
Publication date:
11/28/1997
Edition description:
Older Edition
Pages:
293
Product dimensions:
8.50(w) x 10.70(h) x 0.42(d)

Table of Contents

Preface vii
CHAPTER 1 FROM PATIENT TO PAYMENT
2(14)
Introduction to Medical Insurance
4(1)
The Insurance Claim Process
5(5)
Technology Update: Electronic Media Claims
10(1)
Some Common Types of Medical Insurance
10(1)
The Responsibilities of a Medical Insurance Specialist
11(1)
Effects of Insurance Claim Errors
12(4)
CHAPTER 2 THE LANGUAGE OF ANATOMY
16(22)
Introduction to Medical Terms
18(1)
Musculoskeletal System
19(1)
Integumentary System
20(1)
Circulatory System
21(2)
Endocrine System
23(2)
Professional Focus: The Medical Record
25(1)
Respiratory System
25(1)
Nervous System
26(2)
Special Senses: Sight and Hearing
28(2)
Digestive System
30(2)
Genitourinary System
32(6)
CHAPTER 3 DIAGNOSTIC CODING
38(22)
Introduction to Diagnostic Coding
40(1)
Coding Basics
41(3)
Professional Focus: Using the Superbill
44(1)
Using the ICD
44(5)
Five Steps to Diagnostic Coding
49(6)
Three Reasons to Proofread Numbers
55(5)
CHAPTER 4 PROCEDURAL CODING
60(16)
Introduction to Procedure Codes in the CPT
62(5)
Professional Focus: Certification as a Coder
66(1)
The HCPCS
67(1)
Five Steps for Using the CPT
68(5)
Coding Surgical and Laboratory Procedures
73(3)
CHAPTER 5 THE HCFA FORM
76(40)
Introduction to the HCFA Form
78(6)
Patient and Insured Information
84(10)
Physician or Supplier Information
94(13)
Processing the Claim Form
107(9)
CHAPTER 6 REIMBURSEMENT: MANAGED CARE AND INDEMNITY PLANS
116(12)
The Reimbursement Process
118(1)
Types of Managed Care Plans
118(2)
Methods of Setting Allowed Charges
120(1)
Professional Focus: The Health Insurance Portability and Accountability Act of 1996
121(1)
The Explanation of Benefits
121(3)
Processing Reimbursement Information
124(4)
CHAPTER 7 BLUE CROSS AND BLUE SHIELD
128(8)
Introduction to Blue Cross and Blue Shield
130(1)
Key Features of Blue Cross and Blue Shield Plans
130(1)
Physician Reimbursement
131(1)
Professional Focus: Blue Cross Blue Shield and Managed Care
132(1)
Filing Claims for Special Cases and National Groups
132(1)
Membership Card Information
133(1)
Filing Deadlines
133(3)
CHAPTER 8 MEDICAID
136(8)
Introduction to Medicaid
138(1)
Medicaid Coverage
138(1)
Professional Focus: Managed Care and Medicaid
139(1)
Medicaid Eligibility
139(1)
Filing Medicaid Claims
140(4)
CHAPTER 9 MEDICARE
144(10)
Medicare Overview
146(2)
Filing Medicare Claims
148(1)
Professional Focus: Medicare's Correct Coding Initiative
149(1)
Who Pays First?
149(5)
CHAPTER 10 CHAMPUS CHAMPVA
154(10)
Civilian Health Care for Military Families
156(1)
Billing Beneficiaries
157(1)
Filing for CHAMPUS CHAMPVA Benefits
158(6)
Professional Focus: CHAMPUS and CHAMPVA
158(6)
CHAPTER 11 WORKERS' COMPENSATION
164(10)
When Employees Are Hurt at Work
166(1)
Federal Programs, Forms, and Procedures
166(2)
Professional Focus: Workers' Compensation Terminology
167(1)
State Programs, Forms, and Procedures
168(2)
Keeping Separate Records
170(4)
CHAPTER 12 DISABILITY
174(8)
Replacing Lost Income
176(2)
Professional Focus: Finding a Job as an Insurance Claim Specialist
177(1)
Filing for Disability Benefits
178(4)
CHAPTER 13 DENTAL INSURANCE
182(14)
Introduction to Dental Terms
184(2)
Dental Insurance
186(1)
Professional Focus: Dental Injury Claims and Workers' Compensation
187(1)
Processing Dental Claims
187(9)
CHAPTER 14 LEGAL CONSIDERATIONS
196(8)
Confidentiality of Medical Records
198(1)
Medicolegal Information
198(2)
Medicolegal Records: Retention and Documentation
200(1)
Avoiding Fraud
201(3)
Professional Focus: Fraud and Abuse Legislation
202(2)
CHAPTER 15 REIMBURSEMENT FOLLOW-UP
204(10)
Delinquent Payments
206(1)
Denied or Delayed Payments
207(1)
Claim Rejection Appeals
208(2)
Professional Focus: Explaining Fees to Patients
209(1)
Carrier Audits
210(1)
Answering Patients' Questions about Claims
210(4)
CHAPTER 16 ELECTRONIC MEDIA CLAIMS
214(10)
Using Computers to Process Claims
216(2)
EMC Standards
218(2)
Technology Update: The Medicare Transaction System
219(1)
Steps in the EMC Submission Process
220(4)
CHAPTER 17 GUIDE TO MEDISOFT
224(15)
Introduction to Computerized Medical Office Systems
226(1)
The Medical Practice Database
226(1)
How Insurance Claims Are Created with MediSoft
227(4)
Using MediSoft
231(8)
Technology Update: MediSoft EMC Report
236(3)
CHAPTER 18 HCFA FORM SIMULATIONS
239(18)
Part I: Manual Simulations
240(7)
Part II: Computerized Simulations
247(10)
BLANK HCFA FORMS 257(14)
GLOSSARY 271(14)
INDEX 285

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