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From The CriticsReviewer: LouAnn Schraffenberger, MBA, RHIA, CCS, CCS-P(Advocate Health Care)
Description: The editors state that "the book compiles all the necessary information to keep up with claim processing and payment trends from a variety of insurance and managed care plans." It is a basic text of principles, which allow medical office personnel to build knowledge of working with insurance payers.
Purpose: The purpose is to provide information to the medical office personnel on how to submit insurance claims to third party payers. The subtitle describes an additional purpose: getting paid.
Audience: The audience includes all medical office personnel from the physician to the receptionist. The editors are experienced physician practice managers and credentialed clinical coders who have taught clinical coding and medical billing courses and seminars.
Features: There are twelve chapters in which subjects such as insurance related terms, coding systems, medical documentation, various insurance plans, and quality control programs are covered. At the end of each chapter there are tools, instructional notes, charts, and forms. Each chapter contains a quiz to "exercise knowledge."
Assessment: The editors qualify their book as a tome of recommendations and opinions and not legal, accounting, or medical advice. This may explain why there are so few references noted in the chapters. The book needs some updating of the 1993 and 1994 references that are cited. A couple of mistakes were noted related to coding forms and advice. The strengths of the book are the chapters that address various types of insurance payers and the quality control mechanisms that should be in place in the medical office, related to insurance claims processing.