Prentice Hall
Allied Health
ISBN-10: 0131722522
ISBN-13: 9780131722521
Publisher: Prentice Hall
Copyright: 2007
Format: Paper; 250 pp
Published: 04/07/2006
Suggested retail price: $60.60
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Medical billing is one of the fastest-growing employment opportunities in the United States today. Insurance companies, medical offices, hospitals and other health care providers are in great need of trained personnel to create medical claims. This textbook will ensure learning the skills necessary to become a successful medical claims biller. It is presented in a comprehensive, yet user friendly way, following a logical learning format beginning with a broad base of information and then, step by step, following the course for creation of a medical claim.
This text teaches the skills necessary to become a well-rounded medical biller. By completing this course of study with a satisfactory grade, the user will be granted a certificate and can have the opportunity to work towards an "Honors Certificate", which is even more valuable to a potential employer.
How do you help students focus on key chapter topics?
- Learning Objectives focus the student on the most pertinent topics in each chapter.
Do your students have trouble following the organization of their book?
- Straightforward, easy-to-understand writing style that presents information clearly and concisely.
How do you reinforce the material learned in each chapter?
- Questions for Review at the end of the chapter reinforce key concepts.
How often do your students have hands-on practice?
- Exercises in each chapter give students the opportunity to put knowledge into practice.
What certifications do you currently offer?
- Honors Certification gives the opportunity to graduate from your class "with honors".
What materials do you currently have to start a new program?
- PACER curriculum provides the instructor and training institution with all the necessary materials needed to quickly and easily start and run a new program.
SECTION I. MEDICAL PRACTICE ADMINISTRATION.
1. Introduction to Medical Billing and Coding.
Job Roles and Duties
The Medical Team
Types of Healthcare Settings
Basic Skill Requirements of the Medical Biller
Interpersonal Skills
On The Job Now (Special Feature)
Stress
On The Job Now (Special Feature)
Pre-Vacation Work Planning
Certification Programs for Medical Billers
Legal Issues
Privacy Guidelines
Fraud
HIPAA and Fraud and Abuse
Embezzlement
Employee Bonding and Errors and Omission Insurance
Claim Audits
Practice Pitfalls (Special Feature)
Medical Ethics
Subpoenas
Instances in Which the Patient Should Be Notified and the File Notated
Summary
Assignments
Questions for Review
Exercises 1 — 1 through 1 — 3
Honors Certification™
2. Clinical Records and Medical Documentation.
Medical Charts
Filing the Chart
Medical Documentation Rules
SOAP Notes
Signature Cards
Retention of Records
Practice Pitfalls (Special Feature)
Storing Medical Records
Practice Pitfalls (Special Feature)
Electronic Medical Charting
Computerized Files
Record Transfers
Patient Information Sheet
On The Job Now (Special Feature)
Release of Information Form
Assignment of Benefits Form
Patient History Form
Insurance Verification
Practice Pitfalls (Special Feature)
On the Job Now (Special Feature)
Additional Suggestions
Summary
Assignments
Questions for Review
Exercises 2 — 1 through 2 — 3
Honors Certification™
SECTION II. HEALTH INSURANCE PROGRAMS.
3. Health Insurance Contract Interpretation.
Blue Cross/ Blue Shield
Contract Provisions
On the Job Now (Special Feature)
Contract Benefits
On the Job Now (Special Feature)
On The Job Now (Special Feature)
On The Job Now (Special Feature)
Practice Pitfalls (Special Feature)
On The Job Now (Special Feature)
Practice Pitfalls (Special Feature)
On The Job Now (Special Feature)
Exclusions
Allowed Amounts
Practice Pitfalls (Special Feature)
Pre-certification of Inpatient Admissions
Utilization Review
Second Surgical Opinion Consultations
On The Job Now (Special Feature)
Coordination of Benefits
On The Job Now (Special Feature)
Summary
Assignments
Questions for Review
Exercises 3 — 1 through 3 — 6
Honors Certification™
Sample Insurance Contracts
4. Medicare and Medicaid.
Medicare
Medicare Eligibility
The Parts of Medicare
Practice Pitfall (Special Feature)
On The Job Now (Special Feature)
Allowable Charges
Medicare Health Insurance Card (HIC)
Practice Pitfalls (Special Feature)
Medicare Physician Identification Numbers
Practice Pitfalls (Special Feature)
Medicare Billing Notices
Assignment of Benefits
Practice Pitfalls (Special Feature)
Practice Pitfalls (Special Feature)
Medicare Secondary Payer
Diagnosis-Related Group Billing
On The Job Now (Special Feature)
Durable Medical Equipment
Medicare Denials
Advanced Beneficiary Notice (ABN)
Practice Pitfalls (Special Feature)
The Medicare Appeals Process
Medical Fraud and Abuse
Medicare Supplemental Insurance
Medicare and Managed Care
Medicare Notice of Non-Coverage
Medicare Billing Guidelines
Practice Pitfalls (Special Feature)
Medicaid
Medicaid Covered Services
Reimbursement from Medicaid
Practice Pitfalls (Special Feature)
Medicaid as Secondary Payor
Treatment Authorization Request
Practice Pitfalls (Special Feature)
Medicaid Billing Guidelines
Summary
Assignments
Questions for Review
Exercise 4 — 1 through 4 — 3
Honors Certification™
5. Workers' Compensation.
Intent of the Workers’ Compensation System
Employee Activities
Time Limits
Fraud and Abuse
Types of Workers’ Compensation Benefits
On The Job Now (Special Feature)
Treating Physicians
Medical-Legal Evaluations
Medical Service Order
Patient Records
Doctor's First Report of Injury/Illness
On The Job Now (Special Feature)
Progress Reports
Practice Pitfalls (Special Feature)
Physician's Final Report
Billing for Workers' Compensation Services
Practice Pitfalls (Special Feature)
Third Party Liability
Liens
On The Job Now (Special Feature)
Delinquent Claims
Delay of Adjudication
Workers’ Compensation Appeals
Reversals
Summary
Assignments
Questions for Review
Exercise 5 — 1 through 5 — 2
Honors Certification™
6. Managed Care.
Rising Health Care Costs
Managed Care
HMO Coverage
Preferred Provider Organizations
On The Job Now (Special Feature)
Self Insurance
Billing Managed Care Plans
Practice Pitfalls (Special Feature)
Practice Pitfalls (Special Feature)
On The Job Now (Special Feature)
Practice Pitfalls (Special Feature)
Groups/IPAs
Practice Pitfalls (Special Feature)
Group/IPA to Physician Risk
Capitation Payments
Practice Pitfalls (Special Feature)
Appointment Scheduling
Authorizations, Referrals, and Second Opinions
Denial of Services to Members
Member Grievances and Complaints
Transfers
Disenrollment
Continuing Care
Miscellaneous Services
Practice Pitfalls (Special Feature)
Practice Pitfalls (Special Feature)
Sanctions
Claim Payments
Practice Pitfalls (Special Feature)
Summary
Assignments
Questions for Review
Exercise 6 — 1 through 6 — 3
Honors Certification™
SECTION III. FINANCES AND ACCOUNTING.
7. Medical Practice Accounting.
Patient Accounting
Accounts Payable/ Receivable
Patient Ledger Card/Statement of Account
Insurance Payments
On The Job Now (Special Feature)
Posting Payments
Balance Billing
Follow-Ups
On The Job Now (Special Feature)
Collections
Collections Procedures
Small Claims Court
Practice Accounting
Petty Cash
The Day Sheet/Daily Journal
Office Reports
Summary
Assignments
Questions for Review
Exercise 7 — 1 through 7 — 4
Honors Certification™
SECTION IV. MEDICAL CODING .
8. Reference Books.
ICD-9
CPTâ 9
Medical Dictionary
Merck Manual
On The Job Now (Special Feature)
Physicians' Desk Reference
On The Job Now (Special Feature)
HCPCS
On The Job Now (Special Feature)
On The Job Now (Special Feature)
On The Job Now (Special Feature)
On The Job Now (Special Feature)
Summary
Assignments
Questions for Review
Exercise 8 — l through 8 — 8
Honors Certification™
9. International Classification of Disease (ICD-9) Coding.
History of the ICD-9
Contents of the ICD-9
How to Use the ICD-9
General Guidelines
Practice Pitfalls (Special Feature)
Main Terms
Practice Pitfalls (Special Feature)
On The Job Now (Special feature)
Exceptions
On The Job Now (Special feature)
V Codes
Practice Pitfalls (Special Feature)
E Codes
Signs and Symbols Used in the ICD-9
ICD-10
Summary
Assignments
Questions for Review
Exercises 9 — 1 through 9 — 10
Honors Certification™
10. Current Procedural Terminology (CPTâ) Coding.
Using the CPTâ
Semicolons in the CPTâ
Signs and Symbols Used in the CPTâ
Using the CPTâ Index
Modifiers
Unlisted Codes
Evaluation and Management Codes
On The Job Now (Special feature)
Practice Pitfalls (Special Feature)
Anesthesia
On The Job Now (Special feature)
On The Job Now (Special feature)
Surgery
Practice Pitfalls (Special Feature)
Practice Pitfalls (Special Feature)
On The Job Now (Special feature)
On The Job Now (Special feature)
Radiology/X-ray
On The Job Now (Special feature)
Pathology/Laboratory
On The Job Now (Special feature)
Practice Pitfalls (Special Feature)
On The Job Now (Special feature)
Medicine
On The Job Now (Special feature)
Summary
Assignments
Questions for Review
Exercises 10 — 1 through 10 — 11
Honors Certification™
SECTION V. MEDICAL BILLING.
11. The CMS-1500 Form and Medical Billing Procedures.
Superbill
CMS-1500 Form
CMS-1500 Block Explanations
Practice Pitfalls (Special Feature)
Patient Claim Form
On The Job Now (Special feature)
Billing for Service
Incomplete Data Master List
Determining the Proper Billing Amount
Practice Pitfalls (Special Feature)
Special Services
Claims Submission Process
Practice Pitfalls (Special Feature)
Clean Claims
Coordination of Benefits
COB With Health Maintenance Organizations
Collecting the Patient Portion
Practice Pitfalls (Special Feature)
On The Job Now (Special feature)
TRICARE
Practice Pitfalls (Special Feature)
Billing Reports
Prompt Payment Laws
Tracer Claims/ Delinquent Claims
Denied Claims
Re-submission of Claims
Adjusted Claims
Review and Appeals
Balance Billing Patients for Downcoded or Denied Claims
State Insurance Commissioner
Maximum Reimbursement Guidelines
Summary
Assignments
Questions for Review
Exercise 11 — 1
Honors Certification™
12. The UB-92 Form and Hospital Billing Procedures.
Field Locator # and Name/Description
On The Job Now (Special feature)
Item 42, Hospital Revenue Codes
On The Job Now (Special feature)
On The Job Now (Special feature)
Item 53, Assignment of Benefits
On The Job Now (Special feature)
Practice Pitfalls (Special Feature)
On The Job Now (Special feature)
Chargemaster Descriptions
Entering Charges
How Billing Affects Other Departments
Preauthorization, Pre-certifications and Utilization Reviews
AmbulatorySurgical Centers
Summary
Assignments
Questions for Review
Exercise 12-1 through 12-4
Honors Certification
13. Abstracting, Billing and Coding From Medical Reports.
Abstracting From Medical Records
Triage Reports
Operative Reports
Diagnostic Testing Reports
Medical History and Physical Examination Reports
Summary
Assignments
Questions for Review
Exercises 13 — 1 through 13 — 21
Appendix 13 — 1
Triage Report 1
Triage Report 2
Operative Report 1
Diagnostic Report 1
Medical History and Physical Examination Report
Honors Certification™
SECTION VI. GENERAL OFFICE PROCEDURES.
14. Basic Office Functions and Communications.
On The Job Now (Special feature)
On The Job Now (Special feature)
On The Job Now (Special feature)
Office Machines
Tickler Files
Practice Communications
Practice Pitfalls (Special Feature)
The Opening
The Body
The Closing
Correspondence Containing Negative Content
Format of the Letter
Practice Pitfalls (Special Feature)
On The Job Now (Special Feature)
Practice Pitfalls (Special Feature)
On The Job Now (Special Feature)
Memos
Patient Relations
First Impressions and Image
Customer Service Job Functions
The Art of Listening
On The Job Now (Special Feature)
On The Job Now (Special Feature)
Maintaining an Appointment Calendar
On The Job Now (Special Feature)
Summary
Assignments
Questions for Review
Exercises 4 — 1 through 4 — 3
Honors Certification™
SECTION VII. SECURING EMPLOYMENT.
15. Job Search Preparation.
Key Descriptions
On The Job Now (Special Feature)
Printer Tape Symbols
Calculator Basics
On The Job Now (Special Feature)
The Computer
The Monitor
The Keyboard
On The Job Now (Special Feature)
Practice Pitfalls (Special Feature)
Computer Terms
Practice Pitfalls (Special Feature)
Computer Basics
Job Search Objectives
Uniqueness
Target Audience
Build Your Database
The Resume
Practice Pitfalls (Special Feature)
The Cover Letter
Marketing Yourself
The Job Interview
Getting Paid What You Are Worth
Summary
Assignments
Questions for Review
Exercise 15 — 1 through 15 — 6
Resume Questionnaire
Honors Certification™
SECTION VIII.
Appendix A. Provider and Medical Abbreviations.
Provider Abbreviations
Medical Abbreviations
Appendix B. Forms.
Patient Information Sheet
Patient Encounter Form
Insurance Coverage Form
Pre-authorization Request
Doctor’s First Report of Occupational Injury of Illness
Lien Letter
Lien Form
Statement of Account
Insurance Claim Tracer
Petty Cash Count
Received of Petty Cash
Day Sheet/Daily Journal
Deposit Slip
CMS-1500 Claim Form
UB-92 Billing Form
Patient Claim Form
Superbill/Charge Slip
Return Receipt
Certified Mail Form
Ground Tracking ID COD Prepaid
COD Airbill
COD Shipper Receipt
Ground Tracking ID Prepaid
Airbill
Stationery
Provider Envelope
Appendix C. Tables.
Patient Information Listing
Provider Information Listing
Order of Benefit Determination
Medicare Secondary Payer
Quick Reference Codes
Place of Service Codes
Hospital Revenue Codes
Hospital Field Locator Codes
State Abbreviations
Other Address Abbreviations
Appendix D. CMS-1500 Form Matrix.
CMS-1500 Sample Claims
Appendix E. UB-92 Form Matrix.
UB-92 Sample Claims
Glossary
Answer Keys for “On The Job Now” Exercises
Index
Medical Coding (Medical Assisting)
Administrative Medical Assisting (Medical Assisting)
Medical Billing (Medical Assisting)
Medical Office Procedures (Office Procedures)
Introduction to Health Information Management (Health Information Management)
Medical Billing for Office Administration (Medical Office Administration)
Medical Coding for Office Administration (Medical Office Administration)
- Exercises for Coding and Reimbursement, 2/E
ICDC Publishing, Inc.
© 2007 | Prentice Hall | Paper; 400 pages | Instock
ISBN-10: 0131722530 | ISBN-13: 9780131722538