Guide to Medical Billing / Edition 2

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More About This Textbook

Product Details

  • ISBN-13: 9780131718494
  • Publisher: Pearson
  • Publication date: 5/4/2005
  • Edition description: Older Edition
  • Edition number: 2
  • Pages: 480
  • Product dimensions: 8.50 (w) x 10.80 (h) x 0.80 (d)

Table of Contents

(Note: Each chapter contains a Summary, Assignments, Questions for Review , and Honors Certification)

1. Introduction.

The Historical Perspective

Job Roles and Duties

The Medical Team

Types of Healthcare Settings

Technology and the Medical Biller

Attitudes that Make a Successful

Medical Biller

Workplace Professionalism

Interpersonal Skills

Professional Appearance


Pre-Vacation Work Planning

Detail Orientation

Certification Programs for Medical Billers

Exercises 1 - 1 through 1 - 3

2. Time Management and Prioritizing.


Pressure Projects

Time Management

Counting Time Backwards

Overlapping Projects

Exercises 2 - 1 through 2 - 2

3. Legal Issues.

Privacy Guidelines


HIPAA and Fraud and Abuse



Legal Damages

Medical Ethics


Instances in Which the Patient Should

Be Notified and the File Notated

4. Clinical Records Management.

Medical Charts

Filing the Chart

Medical Documentation Rules

Signature Cards

Retention of Records

Storing Medical Records

Electronic Medical Charting

Computerized Files

Record Transfers

5. Medical Documentation Forms.

Patient Information Sheet

Release of Information Form

Assignment of Benefits Form

Patient History Form

Insurance Verification

Additional Suggestions

Exercise 5 - 1

6. Contract Interpretation.

Blue Cross/ Blue Shield

Contract Provisions

Contract Benefits


Allowed Amounts

Pre-Certification of Inpatient Admissions

Utilization Review

Second Surgical Opinion Consultations

Exercises 6 - 1 through 6 - 5

Sample Insurance Contract

7. Medicare.


Medicare Eligibility

Providers of Service

The Two Parts of Medicare

Approved or Reasonable Charges

Billing Medicare Services

Assignment of Benefits

Coordinating Medicare w/Other Insurance

Estimating Medicare Coverage

Diagnosis-Related Group Billing

Medicare Denials

Medicare Advance Notice

The Medicare Appeals Process

Medical Fraud and Abuse

Medicare Supplement

Medicare and Veterans

Medicare and Managed Care

Medicare Notice of Non-Coverage

Medicare Timeliness Reports

Exercise 7 - 1

8. Medicaid.

Medicaid Billing Procedures

Treatment Authorization Request

Reimbursement from Medicaid

9. Workers' Compensation.

Employee Activities

Time Limits

Types of Claims

Benefits of Workers' Compensation

Workers' Compensation Reform

Medical Service Order

Patient Records

Doctor's First Report

Subsequent Progress Reports

Physician's Final Report

Delay of Adjudication

Billing for Workers' Compensation

Delinquent Claims

Fraud and Abuse

Third Party Liability



Exercise 9-1

10. Managed Care.

Rising Health Care Costs

Decreasing Costs

Managed Care

HMO Coverage

Preferred Provider Organizations

Billing Managed Care


Capitation Payments

Patient Charts

HMO Appointment Scheduling

Authorizations, Referrals, and Second Opinions

Denial of Service to Members

Member Grievances and Complaints



Continuing Care

Miscellaneous Services

Facility Requirements


Claim Payments

11. Miscellaneous Billing Procedures.

Billing for Service

Determining the Proper Billing Amount

Billing Forms

Additional Suggestions

Billing Tips/ Issues

Special Services

Maximum Reimbursement Tips

Collecting the Patient Portion

Patient Claim form

Coordination of Benefits

COB With Health Maintenance Organizations


Exercise 11 - 1

12. Patient Accounting.

Accounts Payable/ Receivable

The Ledger Card

Insurance Payments

Posting Payments

Balance Billing



Collections Procedures

Small Claims Court

Exercise 12 - 1

13. Office Accounting.

Petty Cash

Office Reports

14. Terminology.

Insurance Terminology

Provider Abbreviations

Medical Abbreviations

Medical Symbols

Exercises 14 - 1 through 14 - 4

15. Reference Books.




Physicians' Desk Reference

Medical Dictionary

Merck Manual

Exercises 15 - 1 through 15 - 4

16. ICD-9.

History of the ICD-9

Contents of the ICD-9

How to Use the ICD-9

General Guidelines

Main Terms


V Codes238

E Codes

Signs and Symbols Used in the ICD-D

Billing Tips


Exercises 16 - 1 through 16 - 5

17. CPT Coding.

Using the CPT

Semicolons in the CPT

Signs and Symbols Used in the CPT

Using the CPT Index


Unlisted Codes

Evaluation and Management Codes






Billing Tips

Exercises 17 - 1 through 17 - 10

18. HCPCS Coding.

General Information

Coding Using the HCPCS Manual

Sections of the HCPCS Manual

Transportation Services

Medical and Surgical Supplies

Miscellaneous and Experimental

Enteral and Parenteral Therapy

Temporary Hospital Outpatient PPS

Dental Procedures

Durable Medical Equipment

Procedures and Professional Services

Rehabilitative Services

Drugs Administered Other than Oral Method

Immunosuppressive Drugs

Chemotherapy Drugs

Temporary Codes for DMERCs

Orthotic Procedures

Prosthetic Procedures

Medical Services


Temporary Codes

Diagnostic Radiology Services

Private Payer Codes

State Medicaid Agency Codes

Vision Services

Hearing Services


Exercises 18 - 1 through 18 - 2

19. Medications and the PDR.

Generic vs. Brand Name Drugs

Service Plans

Physicians' Desk Reference



Exercises 19 - 1 through 19 - 3

20. CMS-1500.

Item # and Item Name/ Description

Item 24B, Place of Service

Tips on Completing the CMS-1500

Exercise 20 - 1

21. UB-92 Hospital Billing Form.

Item# and Item Name/Description

Item 4, Type of Bill

Item 19, Type of Admission

Item 20, Source of Admission

Item 22, Patient Status

Items 24-30, Condition Codes

Items 32-35, Occurrence Codes

Item 33, Occurrence

Span Codes and Dates

Items 39-41, Value Codes and Amounts

Item 42, Hospital Revenue Codes

Item 53, Assignment of Benefits

Item 59, Relationship

Item 64, Employment Status Code

Exercise 21 - 1

Appendix 21 - 1 Hospital Revenue Codes

22.Hospital Billing.

Which Claim Form Is Right?

Charge Description Masters

Entering Charges

How Billing Affects Other Departments

Preauthorization, Pre-certifications and Utilization Reviews

Ambulatory Surgical Centers

23. Medical Reports.

Abstracting From Medical Records

Triage Reports

Operative Reports

Diagnostic Testing Reports

Medical History and Physical

Examination Reports

Exercises 23 - 1 through 23 - 20

Appendix 23 - 1

24. Claims Submission Process.

Clean Claims

Incomplete Data Master List

Submission Time Limits

Optical Scanning Guidelines

Submitting the Claims

Electronic Claims Submission

Billing Reports

Tracer Claims/ Delinquent Claims

Denied Claims


Adjusted Claims


Balance Billing Patients for Downcoded or Denied Claims

State Insurance Commissioner

25. Calculator Basics.

Key Descriptions

Printer Tape Symbols

Exercises 25 - 1 through 25 - 4

26. General Office Procedures.


Ordering Supplies

Office Machines

Tickler Files

27. Customer Service/Patient Relations.

Understanding Needs

Attitudes and Feelings

First Impressions and Image

Characteristics of Client Relations

Customer Service Job Functions

The Art of Listening

Handling Difficult Clients

Handling Unwanted Callers


Telephone Techniques

Phone Calls

Telephone Etiquette

Maintaining an Appointment Calendar

Exercises 27 - 1 through 27 - 7

28. Computer Basics.

The Computer

The Monitor

The Keyboard

Frustration Free Computing

Computer Terms

29. Correspondence for the Medical Office.

The Opening

The Body

The Closing

Correspondence Containing Negative Content

Format of the Letter


Postal Abbreviations

Exercises 29 - 1 through 29 - 2

30. Job Search Preparation.

Job Search Objectives


Target Audience

Build Your Database

The Resume

The Cover Letter

Marketing Yourself

The Job Interview

Getting Paid What You Are Worth

Exercise 30 - 1

Resume Questionnaire

Sample Resume # 1

Sample Cover Letter # 1

Sample Resume # 2

Sample Resume # 3

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