**Selected for Doody’s Core Titles� 2024 in Managed Care** Master the complexities of health insurance with this easy-to-understand guide! Beik’s Health Insurance Today, 8th Edition provides a solid foundation in basics such as the types and sources of health insurance, the submission of claims, and the ethical and legal issues surrounding insurance. It follows the claims process from billing and coding to reimbursement procedures, with realistic practice on the Evolve companion website. This edition adds up-to-date coverage of cybersecurity, COVID-19, crowdfunding for medical bills, and cost/value calculators. Making difficult concepts seem anything but, this resource prepares you for a successful career as a health insurance professional.
- Direct, conversational writing style makes learning insurance and billing concepts easier.
- Clear and attainable learning objectives, with chapter content that follows the order of the objectives, make learning easier for students and make chapter content easier to teach for educators.
- Learning features include review questions, scenarios, and additional exercises to ensure comprehension, critical thought, and application to practice.
- Hands-on practice with a fillable CMS-1500 form and accompanying case studies and unique UB-04 forms on the companion Evolve website, ensure practicum- and job-readiness.
- HIPAA Tips emphasize the importance of privacy and government rules and regulations, ensuring a solid foundation in regulatory compliance.
- NEW! Additional content on cybersecurity emphasizes the importance of keeping digital information private and secure.
- NEW! Information on crowdfunding for medical bills discusses how this practice affects billing.
- NEW! Geographic Practice Cost Indexes/Resource Based Relative Value Scale (GPCI/RBPVU) calculators are included.
- NEW! Coverage of COVID-19 explores its impact on billing, reimbursement, and employment.
Table of Contents
UNIT I BUILDING A FOUNDATION1 The Origins of Health Insurance
2 Tools of the Trade: A Career as a Health Insurance Professional
3 The Legal and Ethical Side of Health Insurance
4 Healthcare Reform: Coverage Types and Sources
5 The Patient and the Billing Process
UNIT II HEALTH INSURANCE BASICS
6 Reimbursement Models
7 Understanding Managed Care
8 Understanding Medicare
9 Understanding Medicaid
10 Understanding Military Carriers
11 Understanding Miscellaneous Carriers: Workers' Compensation and Disability Insurance
UNIT III CLAIMS SUBMISSION
12 Claim Submission Methods
13 Diagnostic Coding
14 Procedural, Evaluation and Management, and HCPCS Coding
15 Claims Management
UNIT IV ADVANCED APPLICATION
16 The Role of Computers in Health Insurance
17 Reimbursement Procedures: Getting Paid
18 Hospital Billing and the UB-04
Appendix A: Sample Blank CMS-1500 (02/12)
Appendix B: CMS-1500 Claim Forms and Completion Instructions
Appendix C: UB-04 Claim Forms and Completion Instructions
Glossary
Index
