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Understanding Health Insurance: A Guide to Billing and Reimbursement 11th Edition

Michelle A. Green

  • Published
  • Previous Editions 2011, 2008, 2006
  • 800 Pages

Overview

Understanding Health Insurance, Eleventh Edition, is the essential learning tool you need when preparing for a career in medical insurance billing. This comprehensive and easy-to-understand text is fully-updated with the latest code sets and guidelines, and covers important topics in the field like managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. The eleventh edition has been updated to include new legislation that affects healthcare, ICD-10-CM coding, implementing the electronic health record, the Medical Integrity Program (MIP), medical review process, and more. The practice exercises in each chapter provide plenty of review, and the accompanying workbook—sold separately—provides even more application-based assignments and additional case studies for reinforcement. Includes free online StudyWARE™ software that allows you to test your knowledge, free online SimClaim™ CMS-1500 claims completion software, and free-trial access to Ingenix's EncoderPro.com—Expert encoder software.

Michelle A. Green, Mount Wachusett Community College, Gardner, Massachusetts

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.
  • ICD-10-CM Coverage- New chapter 6b includes covers ICD-10-CM and includes an overview of ICD-10-PCS to bridge the transition in the classroom.
  • Fully updated to the latest available code sets; ICD-10-CM code mapping included in relevant chapters.
  • Expanded content covering medical documentation and the electronic health record (EHR) added to Chapter 2.
  • Chapter 5 includes new legislation and coverage of the Medical Integrity Program (MIP), medical review process, and HIPAA's Title III.
  • SimClaim CMS-1500 practice software has been updated to map to the textbook claims completion instructions, with improved functionality in feedback mode, targeted block help with video, and the option to print completed forms to PDF for easy emailing.
  • 59-day free trial of Encoder Pro.com—Expert™ from Ingenix lets you look up codes and descriptions quickly and with greater accuracy.
  • Alerts such as the HIPAA Alerts, Coding Tips, ICD-10, and Managed Care Alerts draw attention to critical areas of content and provide experience-based recommendations.
  • Notes appear throughout and clarify content, give references, provide background, or emphasize rule exceptions.
  • Study Checklist at the end of each chapter directs you to other learning aids to enhance understanding and build confidence.
  • Free StudyWare™ online practice software provides chapter quizzes and games for practice and self-testing, and features unique Coding Case Studies with animations and video to challenge your ICD-9-CM, ICD-10-CM, CPT, and HCPCS Level II coding skills.
1. Health Insurance Specialist Career.
2. Introduction to Health Insurance.
3. Managed Health Care.
4. Processing an Insurance Claim.
5. Legal and Regulatory Issues.
6A. ICD-9-CM Coding.
6B. 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.

Textbook Only Options

Traditional eBook and Print Options

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  • ISBN-10: 1285030230
  • ISBN-13: 9781285030234
  • STARTING AT $17.99

  • ISBN-10: 1133283861
  • ISBN-13: 9781133283867
  • Bookstore Wholesale Price $138.75
  • RETAIL $184.95

  • ISBN-10: 113328373X
  • ISBN-13: 9781133283737
  • Bookstore Wholesale Price $138.75
  • RETAIL $184.95

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™.