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Overview

Give students the essential learning tool to prepare for a successful career in medical insurance billing with UNDERSTANDING HEALTH INSURANCE, 13E. This comprehensive, easy-to-understand, updated text presents the latest code sets and guidelines. Students examine important topics, such as managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. Updates address new legislation that impacts health care, including the Affordable Care Act (Obamacare); ICD-10-CM coding; electronic health records; Medicaid Integrity Contractors; case mix management; hospital-acquired conditions; present on admission; and value-based purchasing. Practice exercises and the workbook (available separately) provide extensive review, application-based assignments, case studies and CMRS, CPC-P, and CPB Mock Exams. New editions also include online access to SimClaim™ CMS-1500 claims completion software and Optum’s EncoderPro.com Expert™.

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.
  • UPDATES REFLECT THE LATEST CODING: ICD-10-CM codes have been updated throughout this edition, while ICD-9-CM is presented as a legacy classification system.
  • NEW FEATURES ENCOURAGE INTERACTIVE LEARNING: Dynamic hands-on coding cases and quizzing, available in MindTap® and within the book’s wealth of online resources, facilitate a practical understanding of concepts and mastery of skills.
  • REAL FORMS AND PRACTICE SOFTWARE GUIDE STUDENTS THROUGH CLAIMS COMPLETION: CMS-1500 standardized forms appear throughout this edition, giving students hands-on practice with manual insurance claims. In addition, SimClaim™ practice software, available online with each new edition, familiarizes readers with the electronic version of this commonly used claim.
  • ENCODER SOFTWARE PROVIDES PROFESSIONAL PRACTICE: Students use Optum’s leading professional software -- EncoderPro.com Expert™ -- to assign and verify ICD-10-CM, CPT®, and HCPCS level II codes.
  • EXPANDED PRATICE THROUGHOUT THE WORKBOOK PREPARES STUDENTS FOR ON-THE-JOB SUCCESS: The invaluable Workbook (available separately) provides more practice, application-based assignments and case studies as well as a new CPB Mock Exam.
  • 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.
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.
MindTap
Each MindTap product offers the full, mobile-ready textbook combined with superior and proven learning tools at one affordable price. Students who purchase digital access can add a print option at any time when a print option is available for their course.

This Cengage solution can be seamlessly integrated into most Learning Management Systems (Blackboard, Brightspace by D2L, Canvas, Moodle, and more) but does require a different ISBN for access codes. Please work with your Cengage Learning Consultant to ensure the proper course set up and ordering information. For additional information, please visit the LMS Integration site.

Standalone Digital Access — Ultimate Value

Recommended and most popular

  • ISBN-10: 1305647513
  • ISBN-13: 9781305647510
  • Bookstore Wholesale Price $147.00
  • RETAIL $147.00

  • ISBN-10: 133711748X
  • ISBN-13: 9781337117487
  • Bookstore Wholesale Price $168.00
  • RETAIL $168.00

Digital Access + Print — Flexible Value

Recommended and most popular

  • ISBN-10: 1337191558
  • ISBN-13: 9781337191555
  • Bookstore Wholesale Price $151.00
  • RETAIL $200.95

  • ISBN-10: 1337368768
  • ISBN-13: 9781337368766
  • Bookstore Wholesale Price $161.00
  • RETAIL $213.95

Textbook Only Options

Traditional eBook and Print Options

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  • ISBN-10: 1337338826
  • ISBN-13: 9781337338820
  • STARTING AT $31.99

  • ISBN-10: 1305647386
  • ISBN-13: 9781305647381
  • Bookstore Wholesale Price $141.00
  • RETAIL $187.95

  • ISBN-10: 1305647424
  • ISBN-13: 9781305647428
  • Bookstore Wholesale Price $141.00
  • RETAIL $187.95

“I am a fan of this book and I do think the key terms are helpful in the learning process. From the time I added this book to our curriculum until now this book has grown and has only gotten better over time. It's a great book and has well written content. We are enjoying MindTap, and I do feel it is benefiting the students with hands-on examples...very pleased that the MindTtap walks students through the filling out of the insurance claims. I think the SimClaims are very helpful and provide hands-on experience for the students.”

“I’m convinced that the higher course ratings and grades were, in large part, a result of students’ engagement. It was an unmitigated success.”

“Almost across the board, students using MindTap improved on the main learning objectives of the class ...I’ve never seen any results like this.”

“MindTap was very useful – it was easy to follow and everything was right there.”

“MindTap puts practice questions in a format that works well for me.”

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™.