Gain the medical insurance skills you need to succeed in today's outpatient and inpatient settings! Fordney's Medical Insurance and Billing, 16th Edition helps you master the insurance billing specialist's role and responsibilities in areas such as diagnostic coding, procedural coding, billing, and collection. Using clear, easy-to-understand explanations, this book covers all types of insurance coverage commonly encountered in hospitals, physicians' offices, and clinics. Step-by-step guidelines lead you through medical documentation and administrative procedures. Written by coding specialist and educator Linda M. Smith, this market-leading text is a complete guide to becoming an efficient insurance billing specialist.
- Coverage of medical documentation, diagnostic coding, and procedural coding provides you with the foundation and skills needed to work in a physician's office as well as outpatient and inpatient settings. - Coverage of the role and responsibilities of the insurance billing specialist emphasizes advanced job opportunities and certification. - Step-by-step procedures detail common responsibilities of the insurance billing specialist and coder. - Key terms and abbreviationsare defined and emphasized, reinforcing your understanding of new concepts and terminology. - Color-coded icons denote and clarify information, rules, and regulations for each type of payer. - Privacy, Security, and HIPAA chapter and Compliance Alerts throughout the book highlight important HIPAA compliance issues and regulations. - NEW! Insights From The Field includes short interviews with insurance billing specialists who have experience in the field, providing a snapshot of their career paths and offering advice to the new student. - NEW! Scenario boxes help you apply concepts to real-world situations. - NEW! Quick Review sections summarize chapter content and also include review questions. - NEW! Discussion Points provide the opportunity for students and instructors to participate in interesting and open dialogues related to the chapter's content. - NEW! Expanded Health Care Facility Billing chapters are revised to provide the latest information impacting the insurance billing specialist working in a variety of healthcare facility settings. - NEW! Insights From The Field includes short interviews with insurance billing specialists who have experience in the field, providing a snapshot of their career paths and offering advice to the new student. - NEW! Scenario boxes help you apply concepts to real-world situations. - NEW! Quick Review sections summarize chapter content and also include review questions. - NEW! Discussion Points provide the opportunity for students and instructors to participate in interesting and open dialogues related to the chapter's content. - NEW! Expanded Health Care Facility Billing chapters are revised to provide the latest information impacting the insurance billing specialist working in a variety of healthcare facility settings.
- Coverage of medical documentation, diagnostic coding, and procedural coding provides you with the foundation and skills needed to work in a physician's office as well as outpatient and inpatient settings. - Coverage of the role and responsibilities of the insurance billing specialist emphasizes advanced job opportunities and certification. - Step-by-step procedures detail common responsibilities of the insurance billing specialist and coder. - Key terms and abbreviationsare defined and emphasized, reinforcing your understanding of new concepts and terminology. - Color-coded icons denote and clarify information, rules, and regulations for each type of payer. - Privacy, Security, and HIPAA chapter and Compliance Alerts throughout the book highlight important HIPAA compliance issues and regulations. - NEW! Insights From The Field includes short interviews with insurance billing specialists who have experience in the field, providing a snapshot of their career paths and offering advice to the new student. - NEW! Scenario boxes help you apply concepts to real-world situations. - NEW! Quick Review sections summarize chapter content and also include review questions. - NEW! Discussion Points provide the opportunity for students and instructors to participate in interesting and open dialogues related to the chapter's content. - NEW! Expanded Health Care Facility Billing chapters are revised to provide the latest information impacting the insurance billing specialist working in a variety of healthcare facility settings. - NEW! Insights From The Field includes short interviews with insurance billing specialists who have experience in the field, providing a snapshot of their career paths and offering advice to the new student. - NEW! Scenario boxes help you apply concepts to real-world situations. - NEW! Quick Review sections summarize chapter content and also include review questions. - NEW! Discussion Points provide the opportunity for students and instructors to participate in interesting and open dialogues related to the chapter's content. - NEW! Expanded Health Care Facility Billing chapters are revised to provide the latest information impacting the insurance billing specialist working in a variety of healthcare facility settings.
Table of Contents
UNIT 1 Career Role and Responsibilities1 Role of an Insurance Billing Specialist
2 Privacy, Security, and HIPAA
3 Compliance, Fraud, and Abuse
UNIT 2 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 Veterans' Health Care
9 Workers' Compensation
10 Disability Income Insurance and Disability Benefit Programs
UNIT 3 Documentation and Coding for Professional Services
11 Medical Documentation and the Electronic Health Record
12 Diagnostic Coding
13 Procedural Coding
UNIT 4 Claims Submission in the Medical Office
14 The Paper Claim CMS-1500
15 The Electronic Claim
UNIT 5 The Claim Follow-Up and Payment Process
16 Receiving Payments and Insurance Problem Solving
17 Collection Strategies
UNIT 6 Health Care Facility Billing
18 Introduction to Health Care Facilities and Ambulatory Surgery Centers
19 Billing for Health Care Facilities
UNIT 7 Employment
20 Seeking a Job and Attaining Professional Advancement
