Higher Education

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

  • includes Premium Website Printed Access Card and Cengage EncoderPro.com Demo Printed Access Card
  • Michelle A. Green Mount Wachusett Community College, Gardner, Massachusetts
  • ISBN-10: 113328373X  |  ISBN-13: 9781133283737
  • 800 Pages
  • Previous Editions: 2011, 2008, 2006
  • © 2013 | Published
  • College Bookstore Wholesale Price = $138.75
  • Newer Edition Available
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About

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.

Additional Product Information

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 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.
  • 59-day free trial of Encoder Pro.com—Expert™ from Ingenix lets you 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 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.

What's New

  • 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.

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: 1133283861 | ISBN-13: 9781133283867

    List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $138.75

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.

Bundle: Understanding Health Insurance: A Guide to Billing and Reimbursement (with Premium Website Printed Access Card and Cengage EncoderPro.com Demo Printed Access Card), 11th + HIPAA for Health Care Professionals

ISBN-10: 1133423027  | ISBN-13: 9781133423027

List Price = $264.95  | CengageBrain Price = $264.95  | College Bookstore Wholesale Price = $199.25

This Bundle Includes:

  • Understanding Health Insurance: A Guide to Billing and Reimbursement
    List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $138.75
  • HIPAA for Health Care Professionals
    List Price = $80.95  | CengageBrain Price = $80.95  | College Bookstore Wholesale Price = $60.50


ePack: Text + Cengage DLMS Instant Access Code, Student Edition

ISBN-10:  1285924789  | ISBN-13:  9781285924786

List Price = $223.95  | CengageBrain Price = $223.95  | College Bookstore Wholesale Price = $168.75

This Bundle Includes:

  • Understanding Health Insurance: A Guide to Billing and Reimbursement
    List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $138.75
  • Cengage DLMS Instant Access Code, Student Edition
    List Price = $128.00  | CengageBrain Price = $128.00  | College Bookstore Wholesale Price = $128.00


ePack: Text + Student Workbook With Medical Office Simulation Software 2.0 + CourseMate Instant Access

ISBN-10:  128504407X  | ISBN-13:  9781285044071

List Price = $269.95  | CengageBrain Price = $269.95  | College Bookstore Wholesale Price = $202.75

This Bundle Includes:

  • CourseMate Instant Access
    List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $184.95
  • Understanding Health Insurance: A Guide to Billing and Reimbursement
    List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $138.75
  • Student Workbook With Medical Office Simulation Software 2.0
    List Price = $71.95  | CengageBrain Price = $71.95  | College Bookstore Wholesale Price = $54.00


ePack: Text + Student Workbook With Medical Office Simulation Software 2.0 + Learning Lab on Gateway Instant Access Code

ISBN-10:  1285569946  | ISBN-13:  9781285569949

List Price = $295.95  | CengageBrain Price = $295.95  | College Bookstore Wholesale Price = $222.75

This Bundle Includes:

  • Understanding Health Insurance: A Guide to Billing and Reimbursement
    List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $138.75
  • Student Workbook With Medical Office Simulation Software 2.0
    List Price = $71.95  | CengageBrain Price = $71.95  | College Bookstore Wholesale Price = $54.00
  • Learning Lab on Gateway Instant Access, 2 term (12 months)
    List Price = $128.00  | CengageBrain Price = $128.00  | College Bookstore Wholesale Price = $128.00


Bundle: Student Workbook With Medical Office Simulation Software 2.0 + iLabs Printed Access Card for Medical Office Simulation Software 2.0

ISBN-10:  1305608739 | ISBN-13:  9781305608733

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

This Bundle Includes:

  • Student Workbook With Medical Office Simulation Software 2.0
    List Price = $71.95  | CengageBrain Price = $71.95  | College Bookstore Wholesale Price = $54.00
  • iLabs Printed Access Card for Medical Office Simulation Software 2.0
    List Price = $25.00  | College Bookstore Wholesale Price = $25.00


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

Understanding Health Insurance (Book Only)  (ISBN-10: 1133283861 | ISBN-13: 9781133283867)

Updated with the latest code sets, guidelines, and claim forms, UNDERSTANDING HEALTH INSURANCE, Eleventh Edition provides readers with most current information on health insurance billing and reimbursement available on the market. Comprehensive and easy to understand, this book covers important topics in the field including managed health care, legal and regulatory issues, coding systems, reimbursement methods, coding for medical necessity, and common health insurance plans. The eleventh edition has been updated to include relevant topics such as new legislation that affects health care, implementing the electronic health record, the Medical Integrity Program (MIP), medical review process, and release of information. With exercises in each chapter, an accompanying workbook, and access to free software programs, readers will have multiple opportunities to test their knowledge and apply what they've learned.

List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $138.75

Instructor's Resource  (ISBN-10: 1133283748 | ISBN-13: 9781133283744)

The Instructor Resources commonly includes PowerPoint presentations for each core textbook chapter, computerized test bank, Instructor's Manual, and other text-specific resources.

Instructor's Manual  (ISBN-10: 1133283764 | ISBN-13: 9781133283768)

The Instructor's Manual serves as an instructional resource and provides teaching tips or guidelines, essay questions, answers to review and test questions, key objectives, glossary, appendices and exercises for content reinforcement.

Student Workbook With Medical Office Simulation Software 2.0  (ISBN-10: 1133283756 | ISBN-13: 9781133283751)

The student workbook is design to help the user retain key chapter content. Included within this resource are chapter objective questions, key term definition queries, multiple choice, fill in the blank and true or false problems.

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

CourseMate Instant Access  (ISBN-10: 1133283829 | ISBN-13: 9781133283829)

Cengage Learning's CourseMate brings course concepts to life with interactive learning, study, and exam preparation tools that support the printed textbook. Maximize your course success with the integrated eBook and chapter-specific learning tools that include flashcards, quizzes, videos, and more in your CourseMate. Key Features: Interactive eBook, Engagement Tracker, Learning Objectives, Tutorial Quizzes, Glossary and Flashcards, and Web Links and References.

List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $184.95

Premium Web Site Instant Access Code  (ISBN-10: 1133704115 | ISBN-13: 9781133704119)

Designed to help you succeed in your health course, the premium website contains many useful student resources including video tutorials, interactive quizzing, web links, PowerPoint presentations, appendices, datasets, a glossary, and more.

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

WebTutor™ Advantage on Angel, 1 term (6 months) Printed Access Card  (ISBN-10: 1133283853 | ISBN-13: 9781133283850)

Designed to complement the book, WebTUTOR™ Advantage is a content-rich, web-based teaching and learning aid that reinforces and clarifies complex concepts. Online quizzes offer automatic grading and electronic tracking for instructors, and feedback for students to reinforce learning."

List Price = $44.00  | CengageBrain Price = $44.00  | College Bookstore Wholesale Price = $33.00

Cengage DLMS Instant Access Code, Student Edition  (ISBN-10: 1133283888 | ISBN-13: 9781133283881)

Learning Lab is an online homework solution that maps to learning objectives in (Discipline). 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 = $128.00  | CengageBrain Price = $128.00  | College Bookstore Wholesale Price = $128.00

Cengage DLMS Instant Access Code, Institutional Edition  (ISBN-10: 1133283896 | ISBN-13: 9781133283898)

Learning Lab is an online homework solution that maps to learning objectives in (Discipline). 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 = $128.00  | CengageBrain Price = $128.00  | College Bookstore Wholesale Price = $128.00

Learning Lab on Gateway Instant Access, 2 term (12 months)  (ISBN-10: 1133283918 | ISBN-13: 9781133283911)

Learning Lab is an online homework solution that maps to learning objectives in (Discipline). 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 = $128.00  | CengageBrain Price = $128.00  | College Bookstore Wholesale Price = $128.00

Learning Lab on Gateway Instant Access Code, Institutional Edition  (ISBN-10: 1133283926 | ISBN-13: 9781133283928)

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

List Price = $128.00  | College Bookstore Wholesale Price = $128.00

Student Supplements

Understanding Health Insurance (Book Only)  (ISBN-10: 1133283861 | ISBN-13: 9781133283867)

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 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.

List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $138.75

Student Workbook With Medical Office Simulation Software 2.0  (ISBN-10: 1133283756 | ISBN-13: 9781133283751)

The student workbook is design to help the user retain key chapter content. Included within this resource are chapter objective questions, key term definition queries, multiple choice, fill in the blank and true or false problems.

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

CourseMate Instant Access  (ISBN-10: 1133283829 | ISBN-13: 9781133283829)

Cengage Learning's Computers and Technology CourseMate brings course concepts to life with interactive learning, study, and exam preparation tools that support the printed textbook. Access an integrated eBook, learning tools including flashcards, quizzes, and more, all designed specifically to work with UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 11th Edition.

List Price = $184.95  | CengageBrain Price = $184.95  | College Bookstore Wholesale Price = $184.95

Premium Web Site Instant Access Code  (ISBN-10: 1133704115 | ISBN-13: 9781133704119)

Designed to help you succeed in your health course, the premium website contains many useful student resources including video tutorials, interactive quizzing, web links, PowerPoint presentations, appendices, datasets, a glossary, and more.

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

WebTutor™ Advantage on Angel, 1 term (6 months) Printed Access Card  (ISBN-10: 1133283853 | ISBN-13: 9781133283850)

Designed to complement the book, WebTUTOR™ Advantage is a content-rich, web-based teaching and learning aid that reinforces and clarifies complex concepts. Online quizzes offer automatic grading and electronic tracking for instructors, and feedback for students to reinforce learning."

List Price = $44.00  | CengageBrain Price = $44.00  | College Bookstore Wholesale Price = $33.00

Cengage DLMS Instant Access Code, Student Edition  (ISBN-10: 1133283888 | ISBN-13: 9781133283881)

Learning Lab is an online homework solution that maps to learning objectives in (Discipline). 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 = $128.00  | CengageBrain Price = $128.00  | College Bookstore Wholesale Price = $128.00

Cengage DLMS Instant Access Code, Institutional Edition  (ISBN-10: 1133283896 | ISBN-13: 9781133283898)

Learning Lab is an online homework solution that maps to learning objectives in (Discipline). 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 = $128.00  | CengageBrain Price = $128.00  | College Bookstore Wholesale Price = $128.00

Learning Lab on Gateway Instant Access, 2 term (12 months)  (ISBN-10: 1133283918 | ISBN-13: 9781133283911)

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

List Price = $128.00  | CengageBrain Price = $128.00  | College Bookstore Wholesale Price = $128.00

Learning Lab on Gateway Instant Access Code, Institutional Edition  (ISBN-10: 1133283926 | ISBN-13: 9781133283928)

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

List Price = $128.00  | College Bookstore Wholesale Price = $128.00

WebTutor™ Advantage on CC Instant Access  (ISBN-10: 1285534441 | ISBN-13: 9781285534442)

List Price = $44.00  | CengageBrain Price = $44.00  | College Bookstore Wholesale Price = $44.00

Flash Cards Instant Access  (ISBN-10: 1305209958 | ISBN-13: 9781305209954)

Flash cards are effective study aids especially when you only have a limited amount of time. These flash cards work with your title and can help you to review and learn essential terms and key concepts. This is instant access product; at the completion of your purchase, simply go to "My Home" and gain immediate access to your product. Note: If you have purchased CourseMate for your title, flash cards are already included.

List Price = $4.00  | CengageBrain Price = $4.00  | College Bookstore Wholesale Price = $4.00

Flash Cards, 1 term (6 months) Instant Access  (ISBN-10: 1285797418 | ISBN-13: 9781285797410)

Flashcards designed to work with your text can help you to review and learn essential terms and key concepts. Interactive flashcards include terms and definitions for each chapter. This is instant access product; at the completion of your purchase, simply go to "My Home" and gain immediate access to your product. Note: If you have purchased CourseMate for your title, flash cards are already included.

List Price = $4.00  | College Bookstore Wholesale Price = $4.00

Quizzing Instant Access  (ISBN-10: 1305207270 | ISBN-13: 9781305207271)

Quizzes are effective study aids especially when you only have a limited amount of time. These quizzes work with your title and can help you to review and learn essential terms and key concepts. This is instant access product; at the completion of your purchase, simply go to "My Home" and gain immediate access to your product. Note: If you have purchased CourseMate for your title, quizzes are already included.

List Price = $5.00  | CengageBrain Price = $5.00  | College Bookstore Wholesale Price = $5.00

Quizzing, 1 term (6 months) Instant Access  (ISBN-10: 1285793617 | ISBN-13: 9781285793610)

Interactive practice quizzes designed to work with your text can help you to review and learn essential terms and key concepts. True/false and multiple choice questions are included for each chapter. Check your score and take quizzes again if needed. A reference for where to find more material in the text is included with each answer. This is instant access product; at the completion of your purchase, simply go to "My Home" and gain immediate access to your product. Note: If you have purchased CourseMate for your title, flash cards are already included.

List Price = $5.00  | College Bookstore Wholesale Price = $5.00

Quizzing with Flash Cards Instant Access  (ISBN-10: 1285789814 | ISBN-13: 9781285789811)

Interactive practice quizzes and flashcards designed to work with your text can help you to review and learn essential terms and key concepts. Flashcards contain terms and definitions for each chapter. Practice quizzes consist of true/false and multiple choice questions for each chapter. Check your score and take quizzes again if needed. A reference for where to find more material in the text is included with each answer. This is instant access product; at the completion of your purchase, simply go to "My Home" and gain immediate access to your product. Note: If you have purchased CourseMate for your title, practice quizzes and flashcards are already included.

List Price = $6.00  | CengageBrain Price = $6.00  | College Bookstore Wholesale Price = $6.00

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.

Learning Lab

Learning Labs are online Homework solutions that allow your students to practice the most difficult concepts associated with their Cengage Learning textbooks in a simulated real-world environment. Developed to help you improve program quality & retention, Learning Labs prepare your students for their career by increasing comprehension and critical thinking skills. Learning Labs engage students in dynamic skills-based activities and assessments that address all learning styles.

A brief Pretest assesses the student’s understanding at the start of each Learning Lab. Areas of improvement are identified so students know where they need to improve as they progress through each Lab. Learning Activities engage students and simulate real-world environments. Cengage utilizes creative, immersive instruction that is varied and adapts to each students learning style. Immediate feedback is also in place to enhance concept retention. Students can track their progress through immediate feedback in the Pretest and Learning Activities stages. Both students and instructors receive postest grades through their LMS gradebook. Flexible online delivery options make it easier than ever for you to integrate Learning Labs into your classroom and Learning Management System.

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