Prepare for a successful career in medical billing and insurance processing or revenue management with Green's UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2020 Edition. This comprehensive, inviting presentation explains the latest medical code sets and coding guidelines as you learn how to complete health care claims and master revenue management concepts. This edition focuses on today’s most important topics, including managed care, legal and regulatory issues, coding systems and compliance, reimbursement methods, clinical documentation improvement, coding for medical necessity, and common health insurance plans. Updates introduce new legislation that impacts health care; ICD-10-CM, CPT, and HCPCS level II coding; revenue cycle management; and individual health plans. Helpful workbook exercises provide application-based assignments and case studies as well as CMRS, CPC-P, and CPB mock exams. In addition, MindTap digital learning tools offer hands-on practice.
1. Health Insurance Specialist Career.
2. Introduction to Health Insurance.
3. Managed Health Care.
4. Revenue Cycle Management.
5. Legal Aspects of Health Insurance and Reimbursement.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding Compliance, Clinical Documentation Improvement, and Coding for Medical Necessity.
11. CMS-1500 and UB-04 Claims.
12. Commercial Insurance.
13. BlueCross BlueShield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers’ Compensation.
Appendices.
Bibliography.
Glossary.
Index.
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Michelle Green
Michelle Green has been a SUNY Distinguished Teaching Professor in the health information technology department at Mohawk Valley Community College in Utica, New York, since 2017. Ms. Green held the position of SUNY Distinguished Teaching Professor in the physical and life sciences department at the State University of New York, College of Technology for more than 30 years. An active member of the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA), Ms. Green has been recognized both for her excellence in teaching and for her significant contributions to the health information management profession. She has earned numerous awards, including the State University of New York Chancellor’s Award for Excellence in Teaching, Alfred State College’s Alumni Association Teacher of the Year, Who’s Who Among America’s Teachers and AHIMA’s FORE Triumph Educator Award. Ms. Green is a registered health information administrator (RHIA), a fellow of the American Health Information Management Association (FAHIMA) and a certified procedural coder (CPC). She earned an M.P.S. degree from Alfred University and a B.S. from Daemen College. Ms. Green has authored three popular textbooks related to coding, revenue management and health information management.
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NEW LEARNING DESIGN GUIDES READER UNDERSTANDING. This edition's new learning design methodology clearly maps chapter content to both major topics and well-defined learning objectives to keep students focused and progressing.
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UPDATED CONTENT ADDRESSES THE LATEST DEVELOPMENTS IN THE FIELD TODAY. Revised chapter content throughout this edition highlights the latest updates in revenue management, reimbursement methods, health insurance processing, and medical coding.
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ONLINE TOOLS ASSIST IN MASTERY OF ICD-10-PCS CODING AND GUIDELINES. Additional new practice opportunities working with ICD-10-PCS coding and guidelines on the student section of the website offer a variety of application exercises to strengthen coding skills. Answer keys are conveniently located in the online instructor's section.
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UPDATED INSTRUCTIONS INCORPORATE THE LATEST CHANGES IN INSURANCE CLAIMS. Clear instructions for filing insurance claims and corresponding CMS-1500 claims reflect today's requirements. These updates continue throughout the printed book, SimClaim software and the answer key in the instructor’s manual.
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NEW REVIEW QUESTIONS REQUIRE PAYMENT CALCULATIONS TO HELP STRENGTHEN SKILLS. Students now practice calculating insurance or Medicare payments, copayments, and coinsurance as this edition's new review questions help ensure they have mastered these important skills.
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VARIETY OF NEW AND REVISED REVIEW QUESTIONS ENSURE STUDENT UNDERSTANDING. Revised multiple-choice review questions more accurately assess student understanding while additional, new questions check student understanding of the latest key concepts and applications.
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NUMEROUS EXAMPLES CLEARLY ILLUSTRATE HOW TO APPLY PRINCIPLES STUDENTS ARE LEARNING. Memorable examples in each chapter demonstrate how to correctly apply rules and guidelines presented in that chapter.
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SPECIAL LEARNING FEATURES CLARIFY CONTENT AND DIRECT ATTENTION TO THE MOST IMPORTANT CONCEPTS. Coding Tips provide practical suggestions for mastering the use of the CPT, HCPCS, and ICD-10-CM coding manuals. HIPAA Alerts emphasize how recent legislation has impacted privacy and security requirements for patient health information. Special notes in each chapter also highlight important content.
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END-OF-CHAPTER REVIEWS REINFORCE LEARNING. These proven reviews include multiple-choice and short answer questions for students. Answers to Chapter Reviews are available in the instructor’s manual for your convenience.
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ONLINE SIMCLAIM SOFTWARE WITHIN MINDTAP PROVIDES PROFESSIONAL HANDS-ON PRACTICE. Case studies in the software present billing data and patient histories. Students complete data entry on CMS-1500 claims and receive immediate feedback. Clear instructions for using SimClaim appear at the end of the printed book's preface for user convenience.
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KEY TERMS, SECTION HEADINGS, AND LEARNING OBJECTIVES ORGANIZE AND DIRECT LEARNING. Students can use the clear learning objectives at the beginning of each chapter as a self-test for checking comprehension and mastery of chapter content. In addition to well organized content, boldfaced key terms appear throughout each chapter to help students master the technical vocabulary associated with claims processing.
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CODING AND CLAIMS COMPLETION EXERCISES ALLOW STUDENTS TO PRACTICE CONCEPTS AS THEY PROGRESS. Students complete coding exercises throughout Chapters 6, 7, 8, and 10 and work with claims completion exercises in Chapters 11 through 17. Answers to exercises are available in the instructor’s manual for your convenience in checking work.
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CPT, HCPCS LEVEL II, AND ICD-10-CM COVERAGE PRESENTS THE LATEST INFORMATION, EXAMPLES, AND EXERCISES. Students work with the most recent coding information. Numerous examples, skill-building exercises, and detailed content prepare students for the challenges and ongoing changes they will encounter on the job. (ICD-10-PCS content appears in the student’s online companion with answer keys in the instructor’s section.) The accompanying workbook contains additional coding assignments including high-level Bloom’s activities, such as DRG assignment and coding validation.
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STUDENTS PRACTICE COMPLETING BOTH MANUAL AND ONLINE CLAIMS. CMS-1500 claims appear throughout this edition to provide valuable practice with manual claims completion. In addition, SimClaim practice software, available online with each new book, allows students to complete claims electronically. The UB-04 claim appears in Chapter 11 with claims completion instructions and a related exercise. The Workbook to Accompany Understanding Health Insurance also contains additional UB-04 assignments.
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