Understanding Health Insurance: A Guide to Billing and Reimbursement, 2025 Edition,
20th Edition

1. Health Insurance Specialist Career.
2. Introduction to Health Insurance and Managed Care.
3. Introduction to Revenue Management.
4. Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections.
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. CMS-1500 and UB-04 Claims.
11. Commercial Insurance.
12. BlueCross BlueShield.
13. Medicare.
14. Medicaid.
15. TRICARE.
16. 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.

• The 2025 Edition includes updated health insurance and medical billing and reimbursement concepts, focusing on essential skills for healthcare professionals. New content covers artificial intelligence, managed care contracts, risk adjustment methodologies and payment models, and national standard formats for claims submission. Additional new content covers the Medicare drug price negotiation program, Office of the national Coordination for Health Information Technology and it's eHealth Exchange, and Health Information Technology for Economic Clinical Health Act, Medicare [inpatient] code edition, new technology add-on payments, and appeals and denials in individual health insurance chapters.

• Updated MindTap online learning platform! Revisions throughout this edition's digital resources reflect functionality enhancements, customization improvements, and assessment updates

• Carefully updated instructions for completing insurance claims within chapters 11-16.

• Chapters 6–16 include new and revised ICD-10-CM, HCPCS Level II and CPT® codes. All content, related exercises in Chapters 6–8 and chapter reviews reflect the latest coding changes and guidelines and their impact on assigning codes.

• Clear learning objectives at the beginning of each chapter allow students to self-assess comprehension of chapter content. In addition, boldfaced key terms appear throughout each chapter to help students master the technical vocabulary associated with billing, coding, reimbursement and health insurance claims processing. The text's proven learning design methodology clearly maps chapter content, both to major topics to be covered and to well-defined learning objectives.

• Clear instructions for completing CMS-1500 insurance claims reflect current requirements, including any recent changes. Updates to instructions appear throughout the textbook, and SimClaim software is available on the accompanying MindTap Courseware. SimClaim offers multiple case studies that include billing data and patient histories. Auto-graded features provide students with instant feedback.

• Review questions include multiple choice questions to help accurately assess student comprehension of chapter content. Additional questions focus on gauging understanding of key concepts and applications such as practice in calculating insurance or Medicare payments, co-payments and coinsurance. To gain valuable hands-on practice, students can complete coding exercises throughout Chapters 6–8. Answers to exercises are available in the solutions and answer guide.

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.

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