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Overview
Here’s the complete overview of Understanding Health Insurance 14th Edition PDF:
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.
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.
Features of Understanding Health Insurance: A Guide to Billing and Reimbursement 14th Edition PDF
Here’s a quick overview of the essential features of this book:
The book provides a strong and detailed look at the main insurance companies in the USA – Medicare, Medicaid, and BC/BS. The product has MindTap which allows students many more options than before. In addition to the electronic grade book in MindTap, there is also the SimClaim assignments that students can accomplish through the web…The fact that it is all web based is a MAJOR PLUS!
Chapter 11, Essential CMS-1500 Claim Instructions: Very detailed explanation. Lesson is timed appropriately. Good mention of optical scanning guidelines (and) national provider identifier. This chapter provides good detail on all portions of the form. Students retain the information and are able to immediately apply it.
Table of Contents
Below is the complete table of contents offered inside Understanding Health Insurance 14th Edition PDF:
- Table of Contents
- Preface
- About the Author
- Reviewers
- Acknowledgments
- How to Use This Text
- How to Use SimClaim CMS-1500 Software
- Chapter 1: Health Insurance Specialist Career
- Introduction
- Health Insurance Overview
- Health Insurance Career Opportunities
- Education and Training
- Job Responsibilities
- Professionalism
- Chapter 2: Introduction to Health Insurance
- Introduction
- What Is Health Insurance?
- Health Insurance Coverage Statistics
- Major Developments in Health Insurance
- Health Care Documentation
- Electronic Health Record (EHR)
- Health Insurance Marketplace
- Chapter 3: Managed Health Care
- Introduction
- History of Managed Health Care
- Managed Care Organizations
- Managed Care Models
- Consumer-Directed Health Plans
- Accreditation of Managed Care Organizations
- Effects of Managed Care on a Physician’s Practice
- Chapter 4: Revenue Cycle Management
- Introduction
- Revenue Cycle Management
- Encounter Form
- Chargemaster
- Processing an Insurance Claim
- Managing New Patients
- Managing Established Patients
- Managing Office Insurance Finances
- Insurance Claim Revenue Cycle
- Maintaining Insurance Claim Files
- Credit and Collections
- Chapter 5: Legal and Regulatory Issues
- Introduction
- Introduction to Legal and Regulatory Considerations
- Federal Laws and Events That Affect Health Care
- Retention of Records
- Health Insurance Portability and Accountability Act (HIPAA)
- Chapter 6: ICD-10-CM Coding
- Introduction
- ICD-9-CM Legacy Coding System
- Overview of ICD-10-CM and ICD-10-PCS
- ICD-10-CM Coding Conventions
- ICD-10-CM Index to Diseases and Injuries
- ICD-10-CM Tabular List of Diseases and Injuries
- Official Guidelines for Coding and Reporting
- Chapter 7: CPT Coding
- Introduction
- Overview of CPT
- CPT Sections, Subsections,Categories, and Subcategories
- CPT Index
- CPT Modifiers
- Coding Procedures and Services
- Evaluation and Management Section
- Anesthesia Section
- Surgery Section
- Radiology Section
- Pathology and Laboratory Section
- Medicine Section
- Chapter 8: HCPCS Level II Coding
- Introduction
- Overview of HCPCS
- HCPCS Level II National Codes
- Determining Payer Responsibility
- Assigning HCPCS Level II Codes
- Chapter 9: CMS Reimbursement Methodologies
- Introduction
- Historical Perspective of CMS Reimbursement Systems
- CMS Payment Systems
- Ambulance Fee Schedule
- Ambulatory Surgical Center Payment Rates
- Clinical Laboratory Fee Schedule
- Durable Medical Equipment, Prosthetics/Orthotics, and Supplies Fee Schedule
- End-Stage Renal Disease (ESRD) Composite Rate Payment System
- Federally Qualified HealthCenters Prospective Payment System (FQHC PPS)
- Home Health Prospective Payment System
- Hospital Inpatient Prospective Payment System
- Hospital Outpatient Prospective Payment System
- Inpatient Psychiatric Facility Prospective Payment System
- Inpatient Rehabilitation Facility Prospective Payment System
- Long-Term (Acute) Care Hospital Prospective Payment System
- Skilled Nursing Facility Prospective Payment System
- Medicare Physician Fee Schedule
- Chapter 10: Coding Compliance, Clinical Documentation Improvement, and Coding for Medical Necessity
- Introduction
- Coding Compliance
- Clinical Documentation Improvement
- Coding for Medical Necessity
- Chapter 11: CMS-1500 and UB-Claims
- Introduction
- General Claims Information
- Optical Scanning Guidelines
- Entering Patient and Policyholder Names
- Entering Provider Names
- Entering Mailing Addresses and Telephone Numbers
- Recovery of Funds from Responsible Payers
- National Provider Identifier (NPI)
- Assignment of Benefits versus Accept Assignment
- Reporting Diagnoses: ICD-10-CM Codes
- Reporting Procedures and Services: HCPCS Level II and CPT Codes
- National Standard Employer Identifier
- Reporting the Billing Entity
- Processing Secondary CMS-1500 Claims
- Common Errors That Delay CMS-1500 Claims Processing
- Final Steps in Processing CMS-1500 Claims
- Maintaining CMS-1500 Insurance Claim Files for the Medical Practice
- UB-04 Claim
- Chapter 12: Commercial Insurance
- Introduction
- Commercial Health Insurance
- Automobile, Disability, and Liability Insurance
- Commercial Claims
- Commercial Secondary Coverage
- Commercial Group Health Plan Coverage
- Chapter 13: BlueCross BlueShield
- Introduction
- History of Bluecross and Blueshield
- Bluecross Blueshield Insurance
- Billing Notes
- Claims Instructions
- Bluecross Blueshield Secondary Coverage
- Chapter 14: Medicare
- Introduction
- Medicare Eligibility
- Medicare Enrollment
- Medicare Part A
- Medicare Part B
- Medicare Part C
- Medicare Part D
- Other Medicare Health Plans
- Employer and Union Health Plans
- Medigap
- Participating Providers
- Nonparticipating Providers
- Mandatory Claims Submission
- Private Contracting
- Advance Beneficiary Notice of Noncoverage
- Experimental and Investigational Procedures
- Medicare as Primary Payer
- Medicare as Secondary Payer
- Medicare Summary Notice
- Billing Notes
- Claims Instructions
- Medicare and Medigap Claims
- Medicare-Medicaid (Medi-Medi) Crossover Claims
- Medicare as Secondary Payer Claims
- Roster Billing for Mass Vaccination Programs
- Chapter 15: Medicaid
- Introduction
- Medicaid Eligibility
- Medicaid-Covered Services
- Payment for Medicaid Services
- Billing Notes
- Claims Instructions
- Medicaid as Secondary Payer Claims
- Mother/Baby Claims
- SCHIP Claims
- Chapter 16: TRICARE
- Introduction
- TRICARE Background
- TRICARE Administration
- CHAMPVA
- TRICARE Options
- TRICARE Special Programs
- TRICARE Supplemental Plans
- Billing Notes
- Claims Instructions
- TRICARE as Secondary Payer
- TRICARE and Supplemental Coverage
- Chapter 17: Workers’ Compensation
- Introduction
- Federal Workers’ Compensation Programs
- State Workers’ Compensation Programs
- Eligibility for Workers’ Compensation Coverage
- Classification of Workers’ Compensation Cases
- Special Handling of Workers’ Compensation Cases
- Workers’ Compensation and Managed Care
- First Report of Injury Form
- Progress Reports
- Appeals and Adjudication
- Fraud and Abuse
- Billing Notes
- Claims Instructions
- Appendix I: Forms
- Appendix II: Dental Claims Processing
- Appendix III: Abbreviations
- Bibliography
- Glossary
- Index
Understanding Health Insurance 14th Edition PDF Free Download
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