A Guide to Health Insurance Billing (with Premium Website Printed Access Card, 1-YR) / Edition 4

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Prepare for career success with this trusted introduction to the world of health insurance billing and the dynamic, growing field of health information management. A GUIDE TO HEALTH INSURANCE BILLING, Fourth Edition, provides a thorough, practical overview of key principles and current practices, from patient registration to claims submission. Now updated to reflect the latest trends, technology, terminology, legal and regulatory guidelines, and coding systems--including ICD-10--the new edition also features a dynamic full-color layout. The text also includes abundant exercises, examples, case studies, and activities focused on real-world applications, including step-by-step procedures for generating, processing, and submitting health insurance claims to commercial, private, and government insurance programs. An access code for SimClaim interactive online billing software is also provided; this program puts billing skills to the test with case studies that require form completion.
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Editorial Reviews

From The Critics
Reviewer:LouAnn Schraffenberger, MBA, RHIA, CCS, CCS-P(Univ of Illinois at Chicago School of Biomed & Health Info Mgmt)
Description:This is a textbook to teach how to do health insurance or medical billing. A CD-ROM complete with source documents for insurance claims submission practice accompanies the book. Available supplements include an instructor's guide and electronic classroom manager.
Purpose:According to the author, the primary objective is to expose students to various health insurance billing topics. The book is intended to provide students with opportunities to become familiar with health insurance terminology, understand the legal implications of insurance billing, develop a basic understanding of medical coding systems, and accurately complete insurance claim forms.
Audience:The audience would likely be students in structured health career programs, such as medical billing, billing and coding, health information technology, and others with coursework in health insurance billing in a technical or community college. This is the second edition of the book written by the author, a registered health information administrator and former college educator.
Features:Introductory chapters focus on the career of an insurance billing specialist, legal aspects of insurance billing, introduction to health insurance, and introduction to diagnosis and procedure coding systems. The major portion of the book is devoted to developing an insurance claim, guidelines for completing professional and institutional insurance claim forms, and electronic data interchange. Specific chapters address major health insurance payers'programs, such as Medicare, Medicaid, Blue Cross/Blue Shield, Workers' Compensation, Tricare, and CHAMPVA. The appendixes include a sample clinic practice manual, assignments, and references and the book includes a glossary of terms. Chapters contain learning objectives, key terms, abbreviations, and terminology. Coding exercises are included. Numerous exercises and end of chapter reviews provide measures of student comprehension. The instructor's manual contains answers to all exercises, sample source syllabi, quizzes, midterm, and final examinations.
Assessment:This very comprehensive book has a lot of information for students. Many examples, tables, figures, and exercises are presented to explain concepts and measure student comprehension. The subject matter is covered in a very detailed manner and the book appears to provide students with the knowledge and skills they need to be competent and efficient as medical insurance billers. One small detail that I would change is the orange type used for the exercises, examples, and chapter/paragraph headings, because it is difficult to read. Otherwise, I would recommend that instructors in health career programs who teach a health insurance billing course to seriously consider this book and the supplements for their class.
An entry-level text for anyone learning about the insurance-billing process. Includes a step-by-step guide for submitting insurance claims for commercial insurance, Blue Cross/Blue Shield, Medicare, TRICARE, CHAMPVA, and worker's compensation. Medical coding chapters cover the fundamentals of ICD-9-CM, an introduction to ICD 10, CPT, and HCPS coding systems. The accompanying CD-ROM provides a billing simulation so users can apply skills from the text. Annotation c. Book News, Inc., Portland, OR (booknews.com)
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Product Details

  • ISBN-13: 9781285193595
  • Publisher: Cengage Learning
  • Publication date: 3/25/2013
  • Edition number: 4
  • Pages: 640
  • Sales rank: 525,631
  • Product dimensions: 8.40 (w) x 10.80 (h) x 1.00 (d)

Meet the Author

Marie A. Moisio, M.A., RHIA, has 25 years of experience in health information management. In addition to teaching medical billing, medical coding and health information processing for more than 15 years, she served as director of health information departments in a 400-bed regional medical center and a 450-bed regional psychiatric treatment facility. Her professional experience also includes service as a consultant for several long-term care facilities and physician offices as well as positions in health information management, compliance, coding practices, insurance claim auditing and patient record documentation. Moisio has taught numerous workshops covering legal aspects of health information management and documentation. She is also the author of A GUIDE TO HEALTH INSURANCE BILLING and UNDERSTANDING LABORATORY & DIAGNOSTIC TESTS.
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Table of Contents

1. The Insurance Billing Specialist. 2. Legal Aspects of Insurance Billing. 3. Introduction to Health Insurance. 4. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM/PCS). 5. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). 6. Current Procedural Terminology (CPT) and Healthcare Common Procedure. 7. Developing An Insurance Claim. 8. Common CMS-1500 Completion Guidelines: Private/Commercial Insurance. 9. Electronic Claims Submission. 10. UP-04 (CMS-1450) Completion Guidelines. 11. Blue Cross/Blue Shield. 12. Medicare. 13. Medicaid. 14. TRICARE and CHAMPVA. 15. Workers Compensation. Appendix A: Superiorland Clinic Practice Manual. Appendix B: Assignments: Case Study 2-1 Through Case Study 2-10. Appendix C: Abbreviations. References. Glossary. Index.
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