Understanding Health Insurance,
13th Edition

1. Health Insurance Specialist Career.
2. Introduction to Health Insurance.
3. Managed Health Care.
4. Processing an Insurance Claim.
5. Legal and Regulatory Issues.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding for Medical Necessity.
11. Essential CMS-1500 Claim Instructions.
12. Commercial Insurance.
13. Blue Cross Blue Shield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers? Compensation.
Appendices.
Bibliography.
Glossary.
Index.

• 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.

• UPDATES REFLECT THE LATEST CODING: ICD-10-CM codes have been updated throughout this edition, while ICD-9-CM is presented as a legacy classification system.

• NEW FEATURES ENCOURAGE INTERACTIVE LEARNING: Dynamic hands-on coding cases and quizzing, available in MindTap and within the book’s wealth of online resources, facilitate a practical understanding of concepts and mastery of skills.

• REAL FORMS AND PRACTICE SOFTWARE GUIDE STUDENTS THROUGH CLAIMS COMPLETION: CMS-1500 standardized forms appear throughout this edition, giving students hands-on practice with manual insurance claims. In addition, SimClaim™ practice software, available online with each new edition, familiarizes readers with the electronic version of this commonly used claim.

• ENCODER SOFTWARE PROVIDES PROFESSIONAL PRACTICE: Students use Optum’s leading professional software -- EncoderPro.com Expert™ -- to assign and verify ICD-10-CM, CPT®, and HCPCS level II codes.

• EXPANDED PRATICE THROUGHOUT THE WORKBOOK PREPARES STUDENTS FOR ON-THE-JOB SUCCESS: The invaluable Workbook (available separately) provides more practice, application-based assignments and case studies as well as a new CPB Mock Exam.

• UPDATES REFLECT THE LATEST LEGISLATION: Timely coverage explains details of the Affordable Care Act (Obamacare) and Medicaid Integrity Contractors as well as other emerging developments and issues.

• NEW COVERAGE THOROUGHLY DETAILS HEALTH CARE REIMBURSEMENT: This edition offers thorough content that explains and prepares students to work with case mix management, hospital-acquired conditions, present on admission, and value-based purchasing.

• UPDATES REFLECT THE LATEST CODING: ICD-10-CM codes are updated throughout this edition, while ICD-9-CM is presented as a legacy classification system.

• NEW FEATURES ENCOURAGE INTERACTIVE LEARNING: Dynamic hands-on coding cases and quizzing, available in MindTap® and within the book’s wealth of online resources, ensure you gain a practical understanding of concepts and mastery of skills.

• REAL FORMS AND PRACTICE SOFTWARE GUIDE YOU THROUGH CLAIMS COMPLETION: CMS-1500 standardized forms appear throughout this edition, giving you hands-on practice with manual insurance claims. In addition, SimClaim™ practice software, available online with this edition, familiarizes you with the electronic version of this commonly used claim.

• EXPANDED PRATICE THROUGHOUT THE WORKBOOK (AVAILABLE SEPARATELY) PREPARES YOU FOR ON-THE-JOB SUCCESS: The invaluable workbook (available separately) provides more practice, application-based assignments and case studies as well as a new CPB Mock Exam.

• PROVEN LEARNING FEATURES CLARIFY CONTENT AND CONCEPTS: Special features, such as HIPAA Alerts, Coding Tips, ICD-10 Alerts, and Managed Care Alerts, draw attention to critical areas of content and provide experience-based recommendations. In addition, Notes appear throughout the textbook to clarify content, offer references, provide background, or emphasize rule exceptions.

• WEALTH OF STUDENT RESOURCES ENSURES UNDERSTANDING: The Study Checklist at the end of each chapter directs students to other learning aids that enhance understanding of the chapter’s concepts while building confidence.

• STUDENTS LEARN TO COMPLETE BOTH MANUAL AND ELECTRONIC CLAIMS: CMS-1500 standardized forms appear throughout the text to provide valuable practice with manual insurance claims. In addition SimClaim™ practice software, available online with each new text, familiarizes readers with the electronic version of this commonly used claim.

• CONTEMPORARY CODING RELFECTS THE LATEST ADVANCEMENTS IN THE FIELD: Exhaustive CPT, HCPCS level II, and ICD-10-CM coverage outpaces competing health insurance texts with the latest coding manual information, numerous examples and skill-building exercises. In addition, detailed explanations prepare students for upcoming changes they may encounter on the job.

• ENCODER SOFTWARE PROVIDES PROFESSIONAL-LEVEL, HANDS-ON PRATICE: A 59-day trial version of Encoder Pro.com Expert™ from Optum enables students to look up codes and descriptions quickly and with greater accuracy.

• SPECIAL ALERTS DIRECT YOUR ATTENTION TO KEY CONCEPTS: Throughout the book, HIPAA Alerts, Coding Tips, ICD-10, and Managed Care Alerts emphasize critical areas of content and provide experience-based recommendations.

• HELPFUL NOTES CLARIFY CONTENT: Valuable Notes appear throughout each chapter to further explain content, offer additional references, provide background, or emphasize rule exceptions.

• STUDY CHECKLISTS HIGHLIGHT ADDITIONAL LEARNING AIDS: The Study Checklist at the end of each chapter directs you to other learning aids that you may need to enhance understanding of specific concepts and build your confidence for on-the-job success.

• CONTENT DEMONSTRATES HOW TO COMPLETE CLAIMS MANUALLY AND ONLINE: In addition to ongoing, in-text references to claims and related on-the-job issues, this edition provides important hands-on practice completing actual CMS-1500 claims manually and online with easy-to-follow instructions.

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.