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Medical Billing 101

By Crystal Clack, Linda Renfroe, Michelle M. Rimmer

2nd Edition © 2016
Discipline:Health Care
Course:Health Information Management
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Learn the basics of physican-based medical billing with MEDICAL BILLING 101, 2E. Clear and practical guidelines introduce job responsibilities and basic processes in the medical billing world. Case studies and software tools like SimClaim™ CMS-1500 software offer practice on actual forms to build confidence and understanding of the reimbursement process. This easy-to-use guide starts students off on the right path to becoming a medical billing professional.

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About this product

Learn the basics of physican-based medical billing with MEDICAL BILLING 101, 2E. Clear and practical guidelines introduce job responsibilities and basic processes in the medical billing world. Case studies and software tools like SimClaim™ CMS-1500 software offer practice on actual forms to build confidence and understanding of the reimbursement process. This easy-to-use guide starts students off on the right path to becoming a medical billing professional.

User-friendly text clearly outlines objectives and highlights key information.

Real medical forms such as EOBs, Superbills, and Denied Claims provide hands-on, real-world context that’s essential to mastery of medical billing.

Detailed instructions about the revenue cycle and how to complete claim forms make it easy to think like a professional.

Critical thinking is enhanced with case studies geared to various billing situation, including physician office visits and inpatient physician services.

Table of contents

Chapters

Cover Page
Title Page
Copyright Page
Dedication
Preface
Acknowledgments
About the Authors
Reviewers
How to Use SimClaim CMS-1500 Software
How to Use the EncoderPro.com—Expert 30-Day Free Trial
Chapter 1. Working as a Provider-Based Medical Biller*Preview this chapter
Chapter 2. Overview of the Health Insurance Payment System
Chapter 3. The Codes (ICD-9, ICD-10, CPT, HCPCS Level II, and Modifiers)
Chapter 4. The Forms (Patient Registration, Superbill, and Hospital Sheet)
Chapter 5. The Heart of Medical Billing: The CMS-1500 Form
Chapter 6. Billing for Office Services and Procedures
Chapter 7. Billing for Inpatient and Nursing Facility Services
Chapter 8. Electronic Claims Submissions and Clearinghouses
Chapter 9. EOBs and Payments
Chapter 10. Denials and Appeals
Chapter 11. Maintaining Accounts Receivable, Aging Reports, and Rebilling
Chapter 12. Collections and the State Insurance Commissioner
Appendix I. Case Studies for the CMS-1500 Form
Appendix II. Forms
Appendix III. Commonly Used Acronyms in Medical Billing and Coding
Appendix IV. Medicare Part B Carriers by State
Appendix V. Insurance Commissioners by State
Show more

Chapter 1. Working as a Provider-Based Medical BillerPreview this chapter ↗

What Is a Medical Biller?
Preview this section ↗
Revenue Cycle ↗
Skills and Attributes of a Successful Biller ↗
Work Environments ↗
Importance of Certification ↗
Membership in an Organization
Preview this section ↗
Certified Billing and Coding Specialist (CBCS) ↗
Certified Coding Associate (CCA) ↗
Certified Medical Reimbursement Specialist (CMRS) ↗
Certified Professional Biller (CPB) ↗
Certified Professional Coder (CPC) ↗
Continuing Education Units (CEUs) and Certification ↗
Summary ↗
Review Questions ↗

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