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Understanding Health Insurance: A Guide to Professional Billing, 7th edition, is a comprehensive guide for those learning about health insurance claims processing and reimbursement issues. The text utilizes a step-by-step approach to successful completion of health insurance claims. The objectives of this edition are to 1) introduce information about major third party payers, 2) provide up-to-date information about federal health care regulations, 3) clarify coding guidelines and provide application exercises for each coding system, 4) introduce reimbursement issues, 5) emphasize the importance of coding for medical necessity, and 6) help users develop the skill to complete claims accurately. Numerous examples help clarify key concepts. Case studies and review exercises provide users with numerous opportunities to apply knowledge and develop skills in completing CMS-1500 claims accurately. The textbook CD-ROM and accompanying workbook provide additional exercises and practice in completing CMS-1500 claims electronically. Current information is provided on CPT-5 and ICD-10-CM coding systems. The appendices include information about processing UB-92 (CMS-1450) claims and dental claims.
"...highlights the concepts and procedures that medical assistants and medical claims specialists need to know to prepare and submit accurate health insurance claims."
Preface, Chapter 1 - Health Insurance Specialist—Roles and Responsibilities, Chapter 2 - Introduction to Health Insurance, Chapter 3 - Managed Health Care, Chapter 4 - Life Cycle of an Insurance Claim, Chapter 5 - Legal & Regulatory Considerations, Chapter 6 - ICD-9-CM Coding, Chapter 7 - CPT Coding, Chapter 8 - HCPCS Coding (name change from HCPCS Coding System), Chapter 9 - CMS Reimbursement Issues (name change from HCFA Reimbursement Issues), Chapter 10 - Coding for Medical Necessity (name change from Coding from Source Documents), Chapter 11 - Essential Claims Completion Guidelines (name change from Essential Claim Form Instructions), Chapter 12 - Commercial Claims (name change from Filing Commercial Claims), Chapter 13 - Blue Cross and Blue Shield Plans, Chapter 14 - Medicare, Chapter 15 - Medicaid, Chapter 16 - TRICARE, Chapter 17 - Workers' Compensation, Appendix I - Case Studies: Set One, Appendix II - Clinic Billing Manual and Case Studies: Set Two, Appendix III - Forms, Appendix IV - Answers to Coding Exercises, Appendix V - Using the UHI Student Practice CD-ROM, Appendix VI - Abbreviations, Appendix VII - Common Medical Terminology Prefixes, Suffixes, and Combining Forms, Appendix VIII - Web Sites, Appendix IX -X - Electronic Data Interchange and the UB-92 (CMS-1450), Appendix X - Dental Claims ProcessingInsurance, Appendix XI - Bibliography, Appendix XII - Glossary