- Self-study exercises reinforce your understanding with matching, true/false, multiple-choice, mix and match, and fill-in-the-blank questions, as well as critical thinking assignments. - Key terms and abbreviations at the beginning of each chapter provide a quick reference to the health insurance terminology you need to know. - Study outlines focus your review by listing the key points for each chapter. - Performance objectives make learning easier by highlighting what you need to accomplish in each chapter. - Critical Thinking assignments are based on short, real-world vignettes, preparing you to work in a real medical office and allowing you to apply theory learned from the textbook. - Updated mock fee schedules present the latest information available, for use in completing forms and activities. - Expanded coverage of inpatient insurance billing includes ICD-10 coding and CMS coding, ensuring that you are prepared to work in healthcare facility settings as well as the physician's office and outpatient settings. - Updated information on general compliance issues, HIPAA, the Affordable Care Act, and coding reflects changes to the Fordney's Medical Insurance and Billing, 16th Edition text. - Ambulatory Surgery Center chapter provides the foundation and skills needed for billing in this outpatient setting. - NEW! Additional procedures provide more practice, helping you remember the material.
Table of Contents
Unit One: Career Roles and Responsibilities
1. Role of an Insurance Billing Specialist
2. Privacy, Security and HIPAA
3. Compliance, Fraud and Abuse
Unit Two: Introduction to Health Insurance
4. Basics of Health Insurance
5. The Blue Plans, Private Insurance and Managed Care Plans
6. Medicare
7. Medicaid and Other State Programs
8. TRICARE and Veteran's Health Care
9. Workers Compensation
10. Disability Income Insurance and Disability Benefit Insurance
Unit Three: Documentation and Coding for Professional Services
11. Medical Documentation and the Electronic Health Record
12. Diagnostic Coding
13. Procedural Coding
Unit Four: Claims Submission in the Medical Office
14. The Paper Claim CMS-1500
15. The Electronic Claim
Unit Five: The Claim Follow-Up and Payment Process
16. Receiving Payments and Insurance Problem Solving
17. Collection Strategies
Unit Six: Healthcare Facility Billing
18. Ambulatory Surgery Center
19. Hospital Outpatient and Inpatient Billing
Unit Seven: Employment
20. Seeking a Job and Attaining Professional Advancement
