Understanding Health Insurance: A Guide to Billing and Reimbursement 14th Edition
Prepare students for careers 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, coding guidelines, and health plan claims completion instructions. Students examine managed care, legal and regulatory issues, coding systems and compliance, reimbursement, clinical documentation improvement, coding for medical necessity, and common health insurance. Updates address 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. An accompanying workbook provides application assignments; case studies; review; and CMRS, CPC-P, and CPB mock exams. This edition also offers SimClaim™ CMS-1500 claims completion software online.
- NUMEROUS EXAMPLES CLEARLY ILLUSTRATE HOW TO APPLY PRINCIPLES STUDENTS ARE LEARNING. Memorable examples in each chapter demonstrate how to correctly apply rules and guidelines presented in that chapter.
- NOTES CLARIFY CHAPTER CONTENT AND FOCUS STUDENT ATTENTION ON IMPORTANT CONCEPTS. Coding Tips provide practical suggestions for mastering the use of the CPT, HCPCS, and ICD-10-CM coding manuals. HIPAA Alerts draw attention to the impact of this legislation on privacy and security requirements for patient health information.
- STUDY CHECKLISTS AT THE END OF EACH CHAPTER DIRECT STUDENTS TO OTHER LEARNING AIDS. These and other learning tools enhance understanding of the chapter’s concepts while building confidence. End-of-chapter reviews reinforce learning. They offer multiple-choice with a coding completion fill-in-the-blank format for coding chapters. Answers to chapter reviews are available for your convenience.
- PRACTICE SOFTWARE PROVIDED WITH THE TEXT INCLUDES SIMCLAIM™ SOFTWARE. Case studies in the software present billing data and patient histories. Students complete data entry on CMS-1500 claims and receive immediate feedback. Instructions for using SimClaim™ appear at the end of the textbook’s preface for user convenience.
- KEY TERMS, SECTION HEADINGS, AND LEARNING OBJECTIVES AT THE BEGINNING OF EACH CHAPTER ORGANIZE AND DIRECT LEARNING. Students can use these learning tools at the beginning of each chapter as a self-test for checking comprehension and mastery of chapter content. Boldfaced key terms appear throughout each chapter to help learners master the technical vocabulary associated with claims processing.
- CODING AND CLAIMS COMPLETION EXERCISES ALLOW STUDENTS TO PRACTICE THE CONCEPTS AS THEY PROGRESS. Students work with coding exercises throughout Chapters 6, 7, 8, and 10 and claims completion exercises throughout Chapters 11 through 17. Answers to exercises are available for your convenience in checking work.
- CPT, HCPCS LEVEL II, AND ICD-10-CM COVERAGE PRESENTS THE LATEST INFORMATION, EXAMPLES, AND EXERCISES. Students work with the most recent coding information. Numerous examples, skill-building exercise and detailed content prepares students for challenges and ongoing changes they will encounter on the job.
- STUDENTS PRACTICE COMPLETING BOTH MANUAL AND ONLINE CLAIMS. CMS-1500 claims appear throughout the text to provide valuable practice with manual claims completion. In addition, SimClaim™ practice software, available online with each new text, lets students work with claims electronically. The UB-04 claim appears in chapter 11 with its claims completion instructions.