Understanding Health Insurance,
14th Edition

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.
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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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. 

• 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. 

• 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.

• 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.

• 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.

• 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.

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