Understanding Health Insurance: A Guide to Billing and Reimbursement,
14th Edition

Michelle Green

ISBN-13: 9781337554220 | ISBN-10: 1337554227

Copyright 2019

| Published 2018

| 736 pages

List Price USD $189.95


Prepare for a career in health information management and medical billing and insurance processing with Green's UNDERSTANDING HEALTH INSURANCE, 14E. This comprehensive, inviting book presents the latest code sets and guidelines. Examine today’s most important topics, such as 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, including changes to the Affordable Care Act (Obamacare); ICD-10-CM, CPT, and HCPCS level II coding; revenue cycle management; and individual health plans. Workbook exercises provide application-based assignments and case studies, as well as CMRS, CPC-P, and CPB mock exams.

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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. 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.

  • UPDATED COVERAGE OF HEALTH CARE LEGISLATION ADDRESSES THE LATEST DEVELOPMENTS. New content and the latest presentation of health care legislation in chapters 2, 3, and 5 highlights changes to the Affordable Care Act (Obamacare) that were announced prior to publication of this edition.
  • NEW SIMCLAIM™ SOFTWARE ALLOWS STUDENTS TO APPLY CMS-1500 CLAIMS COMPLETION INSTRUCTIONS. The software works seamlessly with Chapters 11 through 17, providing important hands-on reinforcement of concepts. In addition, the workbook contains additional case studies for student practice.
  • CONTENT DETAILS COMPLIANCE AND DOCUMENTATION IN CODING WITH CLEAR EXAMPLES TO ENSURE UNDERSTANDING. Coding compliance, clinical documentation improvement, and coding for medical necessity topics are located in Chapter 10 with examples that further detail and clarify principles.
  • MERGED PRESENTATION OF REVENUE CYCLE MANAGEMENT NOW APPEARS IN ONE LOCATION. The author has relocated all revenue cycle management topics to Chapter 4 to centralize content. In addition, the author has updated all material to reflect the latest changes.
  • MOCK CERTIFICATION EXAMS PROVIDE VALUABLE OPPORTUNITIES TO PRACTICE TEST-TAKING TECHNIQUES. These mock exams, included in the workbook, show students what to expect on the actual certification exams.
  • STUDENTS PRACTICE COMPLETING BOTH MANUAL AND ONLINE CLAIMS. CMS-1500 claims appear throughout the text to provide valuable practice with manual claims completion. In addition, SimClaim™ practice software, available online with each new text, lets students work with claims electronically. The UB-04 claim appears in chapter 11 with its claims completion instructions.
  • NOTES CLARIFY CHAPTER CONTENT AND FOCUS STUDENT ATTENTION ON IMPORTANT CONCEPTS. Coding Tips provide practical suggestions for mastering the use of the CPT, HCPCS, and ICD-10-CM coding manuals. HIPAA Alerts draw attention to the impact of this legislation on privacy and security requirements for patient health information.
  • KEY TERMS, SECTION HEADINGS, AND LEARNING OBJECTIVES AT THE BEGINNING OF EACH CHAPTER ORGANIZE AND DIRECT LEARNING. Students can use these learning tools at the beginning of each chapter as a self-test for checking comprehension and mastery of chapter content. Boldfaced key terms appear throughout each chapter to help learners master the technical vocabulary associated with claims processing.
  • 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.
  • 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 exercise and detailed content prepares students for challenges and ongoing changes they will encounter on the job.
  • CODING AND CLAIMS COMPLETION EXERCISES ALLOW STUDENTS TO PRACTICE THE CONCEPTS AS THEY PROGRESS. Students work with coding exercises throughout Chapters 6, 7, 8, and 10 and claims completion exercises throughout Chapters 11 through 17. Answers to exercises are available for your convenience in checking work.
  • STUDY CHECKLISTS AT THE END OF EACH CHAPTER DIRECT STUDENTS TO OTHER LEARNING AIDS. These and other learning tools enhance understanding of the chapter’s concepts while building confidence. End-of-chapter reviews reinforce learning. They offer multiple-choice with a coding completion fill-in-the-blank format for coding chapters. Answers to chapter reviews are available for your convenience.
  • PRACTICE SOFTWARE PROVIDED WITH THE TEXT INCLUDES SIMCLAIM™ SOFTWARE. Case studies in the software present billing data and patient histories. Students complete data entry on CMS-1500 claims and receive immediate feedback. Instructions for using SimClaim™ appear at the end of the textbook’s preface for user convenience.

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 and Regulatory Issues.
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. Blue Cross Blue Shield.
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, 14th

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, 14th

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, instructor’s manual, test bank, and more.

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Understanding Health Insurance

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