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Understanding Health Insurance: A Guide to Billing and Reimbursement, 12th Edition

  • includes Premium Website, 2 terms (12 months) Printed Access Card and Cengage EncoderPro.com Demo Printed Access Card
  • Michelle A. Green Mount Wachusett Community College, Gardner, Massachusetts
  • ISBN-10: 1285737520  |  ISBN-13: 9781285737522
  • 832 Pages
  • Previous Editions: 2013, 2011, 2008
  • © 2015 | Published
  • List Price = $ 187.95
  • For quantity discounts, Contact your Representative
  • For single copy purchases, visit CengageBrain.com
  • Newer Edition Available

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About

Overview

Understanding Health Insurance, 12th Edition, is the essential learning tool your students 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 twelfth 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 workbook (available separately) provides even more application-based assignments and additional case studies for reinforcement. Includes free online SimClaim™ CMS-1500 claims completion software, and free-trial access to Optum's EncoderPro.com—Expert encoder software.

Features and Benefits

  • 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 students to other learning aids to enhance understanding and build confidence.
  • Practical Claim Handling: In addition to ongoing, in-text references to claim forms and related on-the-job issues, UNDERSTANDING HEALTH INSURANCE, 12th Edition gives readers practice completing actual CMS-1500 claim forms by hand and online using easy-to-follow instructions.
  • Contemporary Coding: Exhaustive CPT and ICD-10 coverage outpaces competing health insurance texts with the latest coding manual information, numerous examples and skill-building exercises, and detailed explanations that prepare students for upcoming changes while building confidence with new requirements.
  • 59-day free trial of Encoder Pro.com—Expert™ from Optum lets students look up codes and descriptions quickly and with greater accuracy.

Table of Contents

1. Health Insurance Specialist Career.
2. Introduction to Health Insurance.
3. Managed Healthcare.
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.

What's New

  • Expanded EMR: Added coverage of Electronic Medical Records includes more workbook problems for better context and clarity.
  • All-New Coding: Completely revised according to 2014's new ICD-10 code sets, UNDERSTANDING HEALTH INSURANCE, 12th Edition also presents the former ICD-9 codes as a legacy classification system.
  • Interactive Learning: The hands-on coding cases, games, and quizzing available in CourseMate and in our online resources help students understand concepts and master skills faster than book learning alone.
  • Revised Claim Forms: New CMS-1500 standardized forms appear throughout the text for practice with manual insurance claims, while the included SimClaim™ practice software trial familiarizes readers with the electronic version of this commonly used claim form.

Alternate Formats

Choose the format that best fits your student's budget and course goals

To customize your learning solution, contact your Learning Consultant for more information.

  • Book Only

    ISBN-10: 1285737598 | ISBN-13: 9781285737591

    List Price = $187.95  | CengageBrain Price = $187.95

Learning Resource Bundles

Choose the textbook packaged with the resources that best meet your course and student needs. Contact your Learning Consultant for more information.

ePack: Text + Learning Lab: Medical Billing & Reimbursement, Instant Access

ISBN-10: 1305243897  | ISBN-13: 9781305243897

List Price = $226.95  | CengageBrain Price = $226.95


ePack: Printed Text + + Workbook for Understanding Health Insurance (Book Only) + MindTap®Health Care Instant Access

ISBN-10:  1305615123  | ISBN-13:  9781305615120

List Price = $272.95  | CengageBrain Price = $272.95


ePack: Text + MindTap® Health Care Instant Access

ISBN-10:  130542767X  | ISBN-13:  9781305427679

List Price = $200.95  | CengageBrain Price = $200.95


Bundle: Text + Workbook + MindTap® Health Care, 2 terms (12 months) Printed Access Card

ISBN-10:  1305412060  | ISBN-13:  9781305412064

List Price = $272.95


Bundle: Understanding Health Insurance: A Guide to Billing and Reimbursement, 12th + Prem. Website, 2 terms (12 months) PAC for Cengage EncoderPro.com Demo Printed Access Card + ICD-10-CM Expert for Physicians 2016 + CPT Professional 2016 (Spiral) + LMS Integrated for MindTap® Health Care, 2 terms (12 mos.) PAC for Understanding Health Insurance: A Guide to Billing and Reimbursement, 12th

ISBN-10:  133707358X | ISBN-13:  9781337073585

List Price = $449.95  | CengageBrain Price = $449.95


Supplements

All supplements have been updated in coordination with the main title. Select the main title's "About" tab, then select "What's New" for updates specific to title's edition.

For more information about these supplements, or to obtain them, contact your Learning Consultant.

Instructor Supplements

Cengage Learning Testing, powered by Cognero Instant Access  (ISBN-10: 1305090381 | ISBN-13: 9781305090385)

Workbook for Understanding Health Insurance (Book Only)  (ISBN-10: 1285737679 | ISBN-13: 9781285737676)

List Price = $71.95  | CengageBrain Price = $71.95  | College Bookstore Wholesale Price = $54.00

CourseMate Instant Access  (ISBN-10: 1285737717 | ISBN-13: 9781285737713)

The more you study, the better the results. Make the most of your study time by accessing everything you need to succeed in one place. CourseMate includes: An interactive eBook with highlighting, note taking, an interactive glossary, and interactive learning tools, including: Homework, Quizzes, Flashcards, PowerPoint® presentations, and more!

List Price = $187.95  | CengageBrain Price = $187.95  | College Bookstore Wholesale Price = $187.95

Premium Web Site, 2 terms (12 months) Printed Access Card  (ISBN-10: 128587451X | ISBN-13: 9781285874517)

List Price = $47.00  | College Bookstore Wholesale Price = $35.25

MindTap® Medical Insurance & Coding, 2 terms (12 months) Instant Access for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement  (ISBN-10: 1305113152 | ISBN-13: 9781305113152)

MindTap™ Health Care for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement, 12th Edition provides you with the tools you need to better manage your limited time -- you can complete assignments whenever and wherever you are ready to learn with course material specially customized for you by your instructor and streamlined in one proven, easy-to-use interface. With an array of tools and apps -- from note taking to flashcards -- you'll get a true understanding of course concepts, helping you to achieve better grades and setting the groundwork for your future courses and a career in medical insurance billing.

List Price = $147.00  | CengageBrain Price = $147.00  | College Bookstore Wholesale Price = $147.00

Learning Lab: Medical Billing & Reimbursement, Instant Access  (ISBN-10: 128573761X | ISBN-13: 9781285737614)

Learning Lab: Medical Billing & Reimbursement is an online homework solution that allows you to practice the most difficult medical billing and reimbursement concepts in a simulated real-world physician's office environment. This Learning Lab prepares you for your career by increasing your comprehension and critical thinking skills.

List Price = $95.00  | CengageBrain Price = $95.00  | College Bookstore Wholesale Price = $95.00

Learning Lab: Medical Billing & Reimbursement, MindLink Instant Access  (ISBN-10: 1285737652 | ISBN-13: 9781285737652)

Learning Lab is an online homework solution that maps to learning objectives in HIM. Interactive case scenarios are used to build students critical thinking skills and help retain the most difficult concepts. This simulated environment engages students with its real-world approach. Learning Labs has a pre-assessment, learning activities and post-assessment.

List Price = $95.00  | College Bookstore Wholesale Price = $95.00

Student Supplements

LMS Integrated for CourseMate™, 2 terms (12 months)Instant Access  (ISBN-10: 1285871316 | ISBN-13: 9781285871318)

List Price = $187.95  | CengageBrain Price = $187.95  | College Bookstore Wholesale Price = $187.95

Workbook for Understanding Health Insurance (Book Only)  (ISBN-10: 1285737679 | ISBN-13: 9781285737676)

List Price = $71.95  | CengageBrain Price = $71.95  | College Bookstore Wholesale Price = $54.00

CourseMate Instant Access  (ISBN-10: 1285737717 | ISBN-13: 9781285737713)

The more you study, the better the results. Make the most of your study time by accessing everything you need to succeed in one place. CourseMate includes: An interactive eBook with highlighting, note taking, an interactive glossary, and interactive learning tools, including: Homework, Quizzes, Flashcards, PowerPoint® presentations, and more!

List Price = $187.95  | CengageBrain Price = $187.95  | College Bookstore Wholesale Price = $187.95

Premium Web Site Instant Access  (ISBN-10: 128587191X | ISBN-13: 9781285871912)

List Price = $47.00  | CengageBrain Price = $47.00  | College Bookstore Wholesale Price = $47.00

Premium Web Site, 2 terms (12 months) Printed Access Card  (ISBN-10: 128587451X | ISBN-13: 9781285874517)

List Price = $47.00  | College Bookstore Wholesale Price = $35.25

LMS Integrated for MindTap® Health Care, 2 terms (12 months) Instant Access  (ISBN-10: 1305113195 | ISBN-13: 9781305113190)

This access code will provide you with seamless access to your MindTap™ Health Care resources from within your campus Learning Management System. You will be prompted to enter this access code the first time that you click on a link in your course that includes Cengage content.

List Price = $147.00  | CengageBrain Price = $147.00  | College Bookstore Wholesale Price = $147.00

MindTap® Medical Insurance & Coding, 2 terms (12 months) Instant Access for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement  (ISBN-10: 1305113152 | ISBN-13: 9781305113152)

MindTap™ Health Care for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement, 12th Edition provides you with the tools you need to better manage your limited time -- you can complete assignments whenever and wherever you are ready to learn with course material specially customized for you by your instructor and streamlined in one proven, easy-to-use interface. With an array of tools and apps -- from note taking to flashcards -- you'll get a true understanding of course concepts, helping you to achieve better grades and setting the groundwork for your future courses and a career in medical insurance billing.

List Price = $147.00  | CengageBrain Price = $147.00  | College Bookstore Wholesale Price = $147.00

Learning Lab: Medical Billing & Reimbursement, Instant Access  (ISBN-10: 128573761X | ISBN-13: 9781285737614)

Learning Lab: Medical Billing & Reimbursement is an online homework solution that allows you to practice the most difficult medical billing and reimbursement concepts in a simulated real-world physician's office environment. This Learning Lab prepares you for your career by increasing your comprehension and critical thinking skills.

List Price = $95.00  | CengageBrain Price = $95.00  | College Bookstore Wholesale Price = $95.00

Learning Lab: Medical Billing & Reimbursement, MindLink Instant Access  (ISBN-10: 1285737652 | ISBN-13: 9781285737652)

Learning Lab is an online homework solution that maps to learning objectives in HIM. Interactive case scenarios are used to build students critical thinking skills and help retain the most difficult concepts. This simulated environment engages students with its real-world approach. Learning Labs has a pre-assessment, learning activities and post-assessment.

List Price = $95.00  | College Bookstore Wholesale Price = $95.00

Meet the Author

Author Bio

Michelle A. Green

Mount Wachusett Community College, Gardner, Massachusetts R Bio: Michelle A. Green, MPS, RHIA, FAHIMA, CPC is an Adjunct Professor in the Health Information Management Department at Mount Wachusett Community College, Gardner, Massachusetts. Ms. Green has also 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.