Authors: Marilyn Fordney
ISBN-13: 9781437701289, ISBN-10: 1437701280
Format: Paperback
Publisher: Elsevier Health Sciences
Date Published: September 2009
Edition: 11st Edition
Marilyn Takahashi Fordney, CMA-AC, CMT, Formerly Instructor of Medical Insurance, Medical Terminology, Medical Machine Transcription, and Medical Office Procedures, Ventura College, Ventura, CA.
INSURANCE HANDBOOK FOR THE MEDICAL OFFICE is a key text for medical administrative assisting, medical front office programs, or those who wish to become insurance billing specialists, claims assistance professionals, or electronic claims processors for physicians' practices and hospital outpatient clinics. Those already practicing in this area will also find this text beneficial, as will health claims examiner programs. The goal of this extremely up-to-date text is to increase efficiency and streamline administrative procedures for the most exasperating aspect of the doctor's office routine: insurance billing. This text offers guidance for all aspects of submitting, tracing, appealing, and transmitting claims for today's full range of health plans. Important coverage of diagnostic coding, procedural coding, office and insurance collection strategies, Medicare, Managed Care, and more is presented. Additionally, a free CD-ROM featuring the HCFA-1500 claim form is included with the book. The CD-ROM contains 10 scored patient case studies with related insurance information so that the student can practice completing the HCFA-1500 claim form in a fun, interactive format.
Unit 1 | Career Role and Responsibilities | |
1 | Role of an Insurance Billing Specialist | 2 |
Unit 2 | The Claims Process | |
2 | Basics of Health Insurance | 20 |
3 | Medical Documentation | 50 |
4 | Diagnostic Coding | 92 |
5 | Procedural Coding | 114 |
6 | The Health Insurance Claim Form | 154 |
7 | Electronic Data Interchange | 236 |
8 | Receiving Payments and Insurance Problem Solving | 258 |
9 | Office and Insurance Collection Strategies | 286 |
Unit 3 | Health Care Payers | |
10 | Managed Care Systems | 330 |
11 | Medicare | 350 |
12 | Medicaid and Other State Programs | 386 |
13 | TRICARE and CHAMPVA | 398 |
14 | Workers' Compensation | 426 |
15 | Disability Income Insurance and Disability Benefits Programs | 466 |
Unit 4 | Inpatient and Outpatient Billing | |
16 | Hospital Billing | 488 |
Unit 5 | Employment | |
17 | Seeking a Job and Attaining Professional Advancement | 528 |
App. A | Addresses for Submitting Claims or Contracting State Insurance Commissioners and State Boards of Medical Examiners | 559 |
App. B | Reference List of Audiotapes, Books, Newsletters, Periodicals, Software, and Videotapes | 593 |
App. C | Medi-Cal | 605 |
App. D | How to Use the Student Software Challenge: Installation and Operating Instructions | 627 |
Glossary | 633 | |
Index | 650 |