Health insurance today : a practical approach
著者
書誌事項
Health insurance today : a practical approach
Elsevier, c2013
4th ed
- : pbk
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注記
Includes bibliographical references and index
内容説明・目次
内容説明
Learn to complete and submit clean claim forms for major insurance carriers. Health Insurance Today, 3rd Edition, provides case studies for each of the chapters covering these major payers so you can learn how to abstract the information from the patient's chart to complete the CMS-1500. You will learn to complete and submit paper claims, but the emphasis is on electronic claims filing, keeping you up-to-date on HIPAA, electronic health records, and the latest industry standards. Select exercises on the companion Evolve Resource site let you gain experience entering information into a practice management program; producing an electronic CMS-1500; and submitting a claim electronically.
Clear, attainable learning objectives help you focus on the most important information.
What Did You Learn? review questions allow you to ensure you understand the material already presented before moving on to the next section.
Direct, conversational writing style makes reading fun and concepts easier to understand.
Imagine This! scenarios help you understand how information in the book applies to real-life situations.
Stop and Think exercises challenge you to use your critical thinking skills to solve a problem or answer a question.
HIPAA Tips emphasize the importance of privacy and following government rules and regulations.
Chapter summaries relate to learning objectives, provide a thorough review of key content, and allow you to quickly find information for further review.
Key coverage of new topics includes medical identity theft and prevention, National Quality Forum (NQF) patient safety measures, ACSX12 Version 5010 HIPAA transaction standards, EMS rule on mandatory electronic claims submission, and standards and implementation specifications for electronic health record technology.
Increased emphasis on producing and submitting claims electronically gives you an edge in today's competitive job market.
UPDATED! Additional ICD-10 coding content prepares you for the upcoming switch to the new coding system.
NEW! Content on ARRA, HI-TECH, and the Health Insurance Reform Act ensures you are familiar with the latest health care legislation and how it impacts what you do on the job.
目次
Unit 1: Building a Foundation
The Origins of Health Insurance
Tools of the Trade: A Career as a Health (Medical) Insurance Professional
The Legal and Ethical Side of Health Insurance
Types and Sources of Health Insurance
Unit 2: Health Insurance Basics
Claim Submission Methods
Traditional Fee-for-Service/Private Plans
Unraveling the Mysteries of Managed Care
Understanding Medicaid
Conquering Medicare's Challenges
Military Carriers
Miscellaneous Carriers: Workers' Compensation and Disability Insurance
Unit 3: Cracking the Codes
Diagnostic Coding
Procedural, E&M, and HCPCS Coding
Unit 4: The Claims Process
The Patient
The Claim
Unit 5: Advanced Application
The Role of Computers in Health Insurance
Reimbursement Procedures: Getting Paid
Hospital Billing and the UB-04
Appendixes
Appendix A: Sample Blank CMS-1500 (08/05)
Appendix B: CMS-1500 Claim Form and Completion Instructions
Appendix C: UB-40 Claim Form and Completion Instructions
Glossary
「Nielsen BookData」 より