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Understanding Health Insurance: A Guide to Billing and Reimbursement 13th Edition

Michelle A. Green

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Overview

UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 13th Edition presents the latest code sets and guidelines. Students examine important topics, such as managed care, legal and regulatory issues, and coding systems. Updates address new legislation that impacts health care, including the Affordable Care Act and ICD-10-CM coding. Practice exercises and the workbook (available separately) offer review and assignments, case studies and CMRS, CPC-P, and CPB Mock Exams. Includes online access to SimClaim™ CMS-1500 claims completion software and Cengage EncoderPro.com Expert™ Access Card.

Michelle A. Green, Mohawk Valley Community College, Utica, New York

Michelle A. Green, MPS, RHIA, FAHIMA, CPC, is an Adjunct Professor in the Health Information Technology Department at Mohawk Valley Community College, Utica, New York. She also teaches in the Health Information Management Department at Mount Wachusett Community College, Gardner, Massachusetts. Ms. Green held the position of SUNY Distinguished Teaching Professor in the Physical and Life Sciences Department at the State University of New York, College of Technology, Alfred, from 1984 through 2016. An active member of the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA), Ms. Green has been recognized both for her excellence in teaching and for her significant contributions to the Health Information Management profession. She has earned numerous awards, including the State University of New York Chancellor’s Award for Excellence in Teaching, Alfred State College’s Alumni Association Teacher of the Year, Who’s Who Among America’s Teachers, and the FORE Triumph Educator Award from the AHIMA. Ms. Green is a Registered Health Information Administrator (RHIA), a Fellow of the American Health Information Management Association (FAHIMA), and a Certified Procedural Coder (CPC). She earned a BS from Daemen College and an MPS degree from Alfred University. Ms. Green has authored three successful books related to coding and health information management.

MindTap® is the digital learning solution that powers students from memorization to mastery. It gives you complete control of your course—to provide engaging content, to challenge every individual, and to build their confidence. Empower students to accelerate their progress with MindTap.

  • ENCODER SOFTWARE PROVIDES PROFESSIONAL-LEVEL, HANDS-ON PRATICE: A 59-day trial version of Encoder Pro.com Expert™ from Optum enables students to look up codes and descriptions quickly and with greater accuracy.
  • PROVEN LEARNING FEATURES CLARIFY CONTENT AND CONCEPTS: Special features, such as HIPAA Alerts, Coding Tips, ICD-10 Alerts, and Managed Care Alerts, draw attention to critical areas of content and provide experience-based recommendations. In addition, Notes appear throughout the textbook to clarify content, offer references, provide background, or emphasize rule exceptions.
  • WEALTH OF STUDENT RESOURCES ENSURES UNDERSTANDING: The Study Checklist at the end of each chapter directs students to other learning aids that enhance understanding of the chapter’s concepts while building confidence.
  • STUDENTS LEARN TO COMPLETE BOTH MANUAL AND ELECTRONIC CLAIMS: CMS-1500 standardized forms appear throughout the text to provide valuable practice with manual insurance claims. In addition SimClaim™ practice software, available online with each new text, familiarizes readers with the electronic version of this commonly used claim.
  • CONTEMPORARY CODING RELFECTS THE LATEST ADVANCEMENTS IN THE FIELD: Exhaustive CPT, HCPCS level II, and ICD-10-CM coverage outpaces competing health insurance texts with the latest coding manual information, numerous examples and skill-building exercises. In addition, detailed explanations prepare students for upcoming changes they may encounter on the job.

Understanding Health Insurance: A Guide to Billing and Reimbursement

TABLE OF CONTENTS

1. Health Insurance Specialist Career.
2. Introduction to Health Insurance.
3. Managed Health Care.
4. Processing an Insurance Claim.
5. Legal and Regulatory Issues.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding for Medical Necessity.
11. Essential CMS-1500 Claim Instructions.
12. Commercial Insurance.
13. Blue Cross Blue Shield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers’ Compensation.
Appendices.
Bibliography.
Glossary.
Index.

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Cengage provides a range of supplements that are updated in coordination with the main title selection. For more information about these supplements, contact your Learning Consultant.

FOR INSTRUCTORS

Instructor’s Companion Web Site

ISBN: 9781305647442
Find everything you need for your course in one place. This collection of product-specific lecture and class tools is available online via the instructor resource center at www.cengage.com/login. You'll be able to access and download materials, such as PowerPoint presentations, instructor’s manual, LMS-downloadable test banks, and more.

Cengage Learning Testing, powered by Cognero®, Instant Access

ISBN: 9781305647466
Cengage Learning Testing, powered by Cognero®, Instant Access for Green’s Understanding Health Insurance: A Guide to Billing and Reimbursement INSTRUCTOR DESCRIPTION: Cengage Learning Testing, powered by Cognero®, is a flexible, online system that allows you to import, edit, and manipulate content from the text’s test bank or elsewhere, including your own favorite test questions. Create multiple test versions in an instant and deliver tests from your LMS, your classroom, or wherever you want.

Student Workbook

ISBN: 9781305647435
The student workbook is design to help your students retain key chapter content. Included within this resource are chapter objective questions; key-term definition queries; and multiple-choice, fill-in-the-blank, and true-or-false problems. The workbook also contains a revised CMRS and CPC-P Mock Exam and a CPB Mock Exam that is new to this edition.

Premium Web Site, 2 terms (12 months) Instant Access

ISBN: 9781305647404
The Premium Website is a password-protected student site that provides access to the SimClaim™ software. Case studies are presented in textbook Appendix I for use within SimClaim™.

FOR STUDENTS

Student Workbook

ISBN: 9781305647435
The student workbook (available separately) is designed to help you retain key chapter content. Included within this resource are chapter objective questions; key-term definition queries; and multiple-choice, fill-in-the-blank, and true-or-false problems. The workbook also contains a revised CMRS and CPC-P Mock Exam and a CPB Mock Exam that is new to this edition.

Premium Web Site, 2 terms (12 months) Instant Access

ISBN: 9781305647404
The Premium Website is a password-protected student site that provides access to the SimClaim™ software. Case studies are presented in textbook Appendix I for use within SimClaim™.