Understanding Health Insurance: A Guide to Billing and Reimbursement - 2021 Edition,
16th Edition

Michelle Green

ISBN-13: 9780357515587 | ISBN-10: 0357515587

Copyright 2022

| Published 2021

| 704 pages

List Price USD $208.95


Develop the skills and background for a career in medical billing and insurance processing or revenue management with Green's UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2021 Edition. This complete resource explains the latest medical code sets and coding guidelines as you learn how to assign ICD-10-CM, CPT, and HCPCS level II codes; complete health care claims and master revenue management concepts. You focus 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 address changes to ICD-10-CM and CPT 2021 codes and introduce electronic claims processing, clinical quality language and other developments. A helpful workbook provides assignments; case studies and CPC-P and CPB mock exams, while MindTap online resources offer practice in CMS-1500 claims and assigning codes.

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Meet the Authors

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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. She was the 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. She has authored three popular textbooks related to coding, revenue management and health information management. An active member of the American Academy of Professional Coders and American Health Information Management Association, Green has been recognized for her excellence in teaching as well as her significant contributions to the health information management profession. Her numerous accolades include 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. In addition, she is a Registered Health Information Administrator, a fellow of the American Health Information Management Association and a Certified Professional Coder. She earned an MPS from Alfred University and a Bachelor of Science from Daemen College.

  • UPDATES TO ICD-10-CM CONTENT REFLECT THE LATEST DEVELOPMENTS. New content within Chapter 6 now details the new ICD-10-CM Chapter 22: Codes for Special Purposes (U00–U85) as well as the CDC's new ICD-10-CM search tool website (https://icd10cmtool.cdc.gov). Corresponding online resources for this edition present additional content and updates for ICD-10-PCS coding.
  • NEW COVERAGE INTRODUCES READERS TO CLINICAL QUALITY LANGUAGE (CQL). New content in Chapter 2 details this all-new clinical language that is becoming critical for CQL-based quality measures today.
  • UPDATES TO CONTENT IN CHS. 6-17 INTEGRATES NEW AND REVISED ICD-10-CM, CPT AND HCPCS LEVEL II CODES. All material in Chapters 6 through 17, including explanations, exercises and activities, now reflects the latest changes in today's coding systems.
  • NEW COVERAGE OF THE TARGETED PROBE AND EDUCATE (TPE) PROCESS FOR MEDICAL REVIEW NOW APPEARS IN CHAPTER 5. Students learn about CMS's Targeted Probe and Educate (TPE) program, designed to help providers and suppliers reduce claim denials and appeals. Insightful discussion helps readers prepare to work with TPE in a professional role, should the need arise.
  • CHAPTER 4 NOW FOCUSES ON ELECTRONIC CLAIMS PROCESSING. Students examine the benefits and limitations of electronic claims processing today as they learn how to use this increasingly popular paperless option that more and more practitioners are relying upon to facilitate the claim reimbursement process.
  • EXPLANATIONS IN CHAPTER 10 NOW INCLUDE A NEW REFERENCE TO CLINICAL DOCUMENTATION INTEGRITY (CDI). Students learn how clinical documentation integrity (CDI) differs as an alternative to clinical documentation improvement (CDI). Students examine how clinical documentation integrity programs focus on clinical documentation excellence and are essential within most healthcare facilities.
  • CHAPTER 9 PROVIDES NEW CONTENT RELATED TO HOME HEALTH PROSPECTIVE PAYMENT. Students examine the latest information about the Home Health Prospective Payment's patient-driven groupings model. They also review data management content about the collection and use of standardized patient assessment data elements (SPADE) for post-acute care (PAC) quality measures.
  • NEW COVERAGE HIGHLIGHTS THE LATEST CPT® 2021 CHANGES. Chapter 7 is now updated to major revisions to the evaluation and management CPT 2021 codes and descriptions. Students learn what must be removed, new requirements for report codes 99202-99215, the basis for code selection and the changing definition of the time element associated with codes.
  • ANNUAL UPDATES ENSURE THE LATEST CONTENT AND DEVELOPMENTS IN HEALTH INSURANCE AND MEDICAL BILLING. This edition includes new content discussing the National Healthcare Association (NHA) and its Certified Billing & Coding Specialist (CBCS) certification in Chapter 1.
  • UPDATED INSTRUCTIONS GUIDE STUDENTS THROUGH ACCURATELY COMPLETING INSURANCE CLAIMS. All insurance claims completion instructions within Chapters 11 through 17 are updated to reflect the latest requirements and to prepare students to seamlessly transition skills to a professional environment.
  • VARIETY OF NEW AND REVISED REVIEW QUESTIONS ENSURE STUDENT UNDERSTANDING. Revised multiple-choice review questions more accurately assess student comprehension, while additional, new questions check student understanding of the latest key concepts and applications.
  • REVIEW QUESTIONS REQUIRE PAYMENT CALCULATIONS TO HELP STRENGTHEN SKILLS. Students gain important practice in calculating insurance or Medicare payments, co-payments and coinsurance as they complete this edition's review questions. The author has incorporated these requirements to ensure students have the practice necessary to master these important skills.
  • UPDATED INSTRUCTIONS INCORPORATE THE LATEST CHANGES IN COMPLETING TODAY'S INSURANCE CLAIMS. Clear instructions for completing CMS-1500 insurance claims reflect the today's requirements and the latest changes. All updates to instructions continue throughout the printed book and SimClaim software as well as the answer keys in the instructor’s manual.
  • ONLINE SIMCLAIM SOFTWARE WITHIN MINDTAP PROVIDES PROFESSIONAL HANDS-ON PRACTICE. Case studies in the SimClaim software present billing data and patient histories. Students complete data entry of CMS-1500 claims and receive immediate feedback. Clear instructions for using SimClaim software appear at the end of the printed book's preface for user convenience.
  • 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.
  • LEARNING DESIGN METHODOLOGY WITH CLEAR OBJECTIVES GUIDES READER UNDERSTANDING. This edition's learning design methodology clearly maps chapter content to both major topics and well-defined learning objectives to keep students focused and progressing.
  • ONLINE TOOLS ASSIST IN MASTERY OF ICD-10-PCS CODING AND GUIDELINES. Content about ICD-10-PCS coding and official guidelines are located at the student online companion website with a variety of application exercises to strengthen coding skills. Answer keys are conveniently located on the password-protected instructor's companion website.
  • 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 complete claims completion exercises in Chapters 11 through 17. Answers to all of these exercises are available in the instructor’s manual for your convenience in checking student work.
  • 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.

Table of Contents

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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.
17. Workers’ Compensation.

Cengage provides a range of supplements that are updated in coordination with the main title selection. For more information about these supplements, contact your Learning Consultant.

Student Workbook for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement - 2021 Edition

The student workbook is design to help you retain key chapter content. Included within this resource are chapter objective questions; key-term definition queries; and multiple choice, fill-in-the-blank, and true-or-false problems.

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Instructor's Companion Website for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement

Everything you need for your course in one place! This collection of product-specific lecture and class tools is available online via the instructor resource center at www.cengage.com/login. You'll be able to access and download materials such as PowerPoint® presentations, images, instructor’s manual, videos, and more.

Cengage Testing, powered by Cognero® for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement - 2021 Edition, Instant Access

Cengage Testing, powered by Cognero® is a flexible, online system that allows you to import, edit, and manipulate content from the text’s test bank or elsewhere, including your own favorite test questions; create multiple test versions in an instant; and deliver tests from your LMS, your classroom, or wherever you want.

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Understanding Health Insurance

  • ISBN-10: 0357515587
  • ISBN-13: 9780357515587

Price USD$ 208.95

eBook: Understanding Health Insurance 12Months

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