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This combination textbook and workbook, explains each phase of the medical claim cycle, from the time the patient calls for an appointment until the financial transaction for the encounter is completed. Coverage includes types of insurance payers, basic coding and billing rules, and standard requirements for outpatient billing using the CMS-1500 claim form. It also emphasizes legal aspects related to each level of the medical claim cycle and the importance of the medical office employee, showing their responsibility for and impact on successful reimbursement.
• 3 separate chapters offer coverage of the basic concepts of medical coding.
• A comprehensive overview of the CMS-1500 claim form with step-by-step guidelines and illustrations thoroughly covers reimbursement issues and explains the billing process.
• Includes detailed information on various insurance payers and plans including Medicare, government medical plans, disability plans, private indemnity plans, and managed care.
• Stop & Review sections illustrate how the concepts presented in each chapter relate to real-life billing situations.
• Sidebars and Examples highlight key concepts and information related to the core text lesson.
• A companion CD-ROM contains sample patient and insurance information that readers can use to practice completing the accompanying CMS-1500 claim form, as well as a demonstration of Altapoint practice management software.
• Features completely updated information that reflects the many changes in the insurance industry.
• Contains a new chapter on UB-92 insurance billing for hospitals and outpatient facilities.
• Includes a new appendix, Quick Guide to HIPAA for the Physician's Office, to provide a basic overview of the important HIPAA-related information necessary on the job.
1. Learning to Speak the Language
2. You’re Part of a Team
3. How the Medical Claim Cycle Works
4. CMS-1500 Claim Form
5. Basic Principles for Diagnosis Coding
6. Basic Principles for Evaluation and Management (E/M) Services
7. Basic Principles of Procedure Coding
8. Private Indemnity and Managed Care Medical Plans
9. Other Plans with Medical Coverage and Disability Plans
11. Other Government Medical Plans
12. Hospital/Facility Rules
13. Reimbursement Success
14. Developing Critical Thinking Skills: Analyzing Problems and Making Decisions
Appendix A Lake Eola Family Practice Associates
Appendix B 1997 Examination Tables
Appendix C Department of Insurance Guide
Appendix D Quick Guide to HIPAA for the Physician’s Office