Understanding Hospital Billing and Coding

by Debra P. Ferenc BS, CPC, CPC-I, CPC-H, CMSCS, PCS, FCS

Overview

A basic guide to hospital billing and reimbursement, Understanding Hospital Billing and Coding, 3rd Edition helps you understand, complete, and submit the UB-04 claim form that is used for all Medicare and privately insured patients. It describes how hospitals are reimbursed for patient care and services, showing how the UB-04 claim form reflects the flow of patient data from the time of admission to the time of discharge. Written by coding expert Debra P. Ferenc, this book also ensures that you understand the essentials of ICD-10-CM and develop skills in both inpatient coding and outpatient/ambulatory surgery coding.

• UB-04 Claim Simulation on the companion Evolve website lets you practice entering information from source documents into the claim form.
• Over 300 illustrations and graphics bring important concepts to life.
• Detailed chapter objectives highlight what you are expected to learn.
• Key terms, acronyms, and abbreviations with definitions are included in each chapter.
• Concept Review boxes reinforce key concepts.
• Test Your Knowledge exercises reinforce lessons as you progress through the material.
• Chapter summaries review key concepts.
• Practice hospital cases let you apply concepts to real-life scenarios.

• UPDATED content reflects the most current industry changes in ICD-10, MR-DRGs, PPS Systems, and the Electronic Health Record.
• NEW Hospital Introduction chapter includes a department-by-department overview showing how today’s hospitals really work
• NEW Health Care Payers and Reimbursement section follows the workflow of the hospital claim by including successive chapters on payers, prospect payment systems, and accounts receivable management.

Product Details

ISBN-13:	9781455723638
Publisher:	Elsevier Health Sciences
Publication date:	02/26/2013
Edition description:	New Edition
Pages:	624
Product dimensions:	8.50(w) x 10.80(h) x 1.00(d)

Table of Contents

Section 1: Hospital Overview

1. Hospital Introduction

2. Hospital Regulatory Environment

3. HIPAA

Section 2: Hospital Billing and Coding Process

4. Patient Accounts Data Flow

5. Hospital Billing Process

Section 3: Coding

6. ICD-9-CM Diagnosis and Procedure Coding

7. ICD-10-CM Diagnosis Coding

8. Procedure Coding (HCPCS and ICD-10-PCS)

9. Coding Guidelines and Applications (HCPCS and ICD-10-CM/PCS)

Section 4: Claim Forms

10. Claim Forms

Section 5: Health Care Payers and Reimbursement

11. Payers

12. Prospective Payment Systems

13. Accounts Receivable Management

Section 6: Appendixes

A: Cases

B: Claim Form Data

C: Web Resources

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From the Publisher

Clear, need-to-know guidelines for hospital billing and coding