Guide to Health Claims Examining: An Honors Certification Textbook / Edition 2

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Overview

Health claims examining and medical billing are two of the fastest-growing employment opportunities in the United States today. Insurance companies, medical offices, hospitals and other health care providers are in great need of trained personnel to create and process claims. With the aid of this text, a student can learn the skills necessary to become a successful health claims examiner. The material has been designed to be comprehensive, yet user-friendly. The text follows a logical learning format by beginning with a broad base of information and then, step by step, following the course of a health claims from billing to examining.
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Product Details

  • ISBN-13: 9780132194082
  • Publisher: Prentice Hall
  • Publication date: 10/25/2006
  • Edition description: Older Edition
  • Edition number: 2
  • Pages: 250
  • Product dimensions: 8.50 (w) x 10.80 (h) x 1.20 (d)

Read an Excerpt

Health claims examining and medical billing are two of the fastest-growing employment opportunities in the United States today. Insurance companies, medical offices, hospitals and other health care providers are in great need of trained personnel to create and process claims.

With the aid of this textbook, you can learn the skills necessary to become a successful health claims examiner. The material has been designed to be comprehensive, yet user-friendly. The text follows a logical learning format by beginning with a broad base of information and then, step by step, following the course of a health claim from billing to examining.

This text may be used with ICDC Publishing's Guide to Medical Billing and the Medical Biller/Health Claims Examiner Curriculum Program. The curriculum is developed in easy-to-understand, standalone modules.

Special Features
The following special features of the text enhance understanding and retention of the material covered:

Each chapter begins with learning objectives to focus the student on the most important topics covered in that chapter. Key words and concepts introduce the student to new terminology and processes. The straightforward, easy-to-understand writing style presents information clearly and concisely. Questions for Review at the end of each chapter are designed to reinforce key concepts. Answering questions without looking back into the chapter will help readers determine if they have grasped the main principles within the chapter or if there is a need for further review. The Questions for Review also serve to prepare students for exams. Exercises provided with most chapters give students the opportunity to put their knowledge into practice. These hands-on, real-life exercises will ensure competence in claims examining. Honors Certification™ challenges encourage students to learn the material in order to graduate from a course "with honors."

Answers for all Questions for Review and Exercises are contained in the instructor materials for the course, along with the Honors Certification™ tests and answers. This material is available to training facilities.

The most important ingredient to success in this course is the desire to learn, without which the learning process is ineffective. The desire to learn can lead you to a rewarding career in the medical billing or health claims examining fields.

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Table of Contents

(NOTE: Each chapter contains Summary, Assignments, Questions for Review, and Honors for Certification.)

1. Introduction to Insurance.

2. Legal Issues.

3. Billing Forms.

4. Resource Manuals.

5. Contracts.

6. Eligibility.

7. Usual, Customary, and Reasonable.

8. Benefit Structures.

9. Cost-Containment Programs.

10. General Plan Provisions.

11. Claims Administration.

12. Effective Communication.

13. Physician’s Services.

14. X-ray and Laboratory.

15. Surgery.

16. Podiatric Surgery.

17. Anesthesia.

18. Hospital Services.

19. Ambulance Expenses.

20. Durable Medical Equipment.

21. Managed Care.

22. Coordination of Benefits.

23. Medicare.

24. Medicaid.

25. Workers’ Compensation.

26. Adjustments.

27. Dental Terminology.

28. Anatomy and Physiology of the Mouth.

29. Dental Services and Coding.

30. Temporomandibular Joint.

31. Dental Claim Form.

32. Dental Benefit Structures.

33. Processing Dental Claims.

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Preface

Health claims examining and medical billing are two of the fastest-growing employment opportunities in the United States today. Insurance companies, medical offices, hospitals and other health care providers are in great need of trained personnel to create and process claims.

With the aid of this textbook, you can learn the skills necessary to become a successful health claims examiner. The material has been designed to be comprehensive, yet user-friendly. The text follows a logical learning format by beginning with a broad base of information and then, step by step, following the course of a health claim from billing to examining.

This text may be used with ICDC Publishing’s Guide to Medical Billing and the Medical Biller/Health Claims Examiner Curriculum Program. The curriculum is developed in easy-to-understand, standalone modules.

Special Features
The following special features of the text enhance understanding and retention of the material covered:

Each chapter begins with learning objectives to focus the student on the most important topics covered in that chapter. Key words and concepts introduce the student to new terminology and processes. The straightforward, easy-to-understand writing style presents information clearly and concisely. Questions for Review at the end of each chapter are designed to reinforce key concepts. Answering questions without looking back into the chapter will help readers determine if they have grasped the main principles within the chapter or if there is a need for further review. The Questions for Review also serve to prepare students for exams. Exercises provided with most chapters give students the opportunity to put their knowledge into practice. These hands-on, real-life exercises will ensure competence in claims examining. Honors Certification™ challenges encourage students to learn the material in order to graduate from a course "with honors."

Answers for all Questions for Review and Exercises are contained in the instructor materials for the course, along with the Honors Certification™ tests and answers. This material is available to training facilities.

The most important ingredient to success in this course is the desire to learn, without which the learning process is ineffective. The desire to learn can lead you to a rewarding career in the medical billing or health claims examining fields.

Read More Show Less

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