Full Description
Gain the skills you need to succeed in insurance coding and billing! Fordney's Medical Insurance and Billing, 17th Edition
helps you master the insurance billing specialist's role and responsibilities in areas such as diagnostic coding, procedural coding, HCPCs coding, medical documentation, billing, and collection. Using clear explanations, this book covers all types of insurance coverage commonly encountered in hospitals, physicians' offices, and clinics. Step-by-step guidelines lead you through the submission of electronic claims and paper claims, as well as the job search and professional advancement. Written by coding specialist and educator Linda M. Smith, this market-leading text is a complete guide to becoming an efficient insurance billing specialist.
NEW HCPCs Coding chapter covers ambulance billing, supply billing, and certificates of medical necessity
NEW! Content on professionalism includes customer service, conflict management, diversity awareness, leadership, and other competencies to help you become an effective, engaged, and highly functioning employee
NEW! Additional content on medical decision making helps you select the appropriate evaluation and management codes under the current documentation guidelines
NEW! Additional examples of CMS claims include those from Blue Shield and Automobile Insurance
NEW! Updates to credentialing include those specific to Medicare, Medicaid, and Workers' Compensation
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 ambulatory and inpatient settings
Coverage of the role and responsibilities of the insurance billing specialist emphasizes advanced job opportunities and certification
Chapter on HIPAA compliance as well as Compliance Alerts highlight important HIPAA compliance issues and the latest regulations
Step-by-step procedures detail common responsibilities of the insurance billing specialist and coder
Key terms and abbreviations are 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
Insights From The Field includes more interviews with experienced insurance billing specialists, providing a snapshot of their career paths and offering advice to the new student
Scenario boxes help you apply concepts to real-world situations
Quick Review sections summarize chapter content and also include review questions
Student Software Challenge on the Evolve website allows you to practice filling out interactive CMS-1500 forms
Contents
Unit 1 Career Role and Responsibilities
1. 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, Automobile, and Liability Insurance
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. ICD-10-CM Coding
13. CPT Coding
14. HCPCS Level II Coding
Unit 4 Claims Submission in the Medical Office
15. The Paper Claim CMS 1500
16. The Electronic Claim
Unit 5 Revenue Cycle Management
17. Receiving Payments and Insurance Problem-Solving
18. Collection Strategies
Unit 6 Health Care Facility Billing
19. Introduction to Health Care Facilities and Ambulatory Surgery Centers
20. Billing for Health Care Facilities
Unit 7 Employment
21. Seeking a Job and Attaining Professional Advancement
