Understanding Health Insurance: A Guide to Billing and Reimbursement 14th Edition PDF Free Download [Direct Link]

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Understanding Health Insurance 14th Edition PDF

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Overview

Here’s the complete overview of Understanding Health Insurance 14th Edition PDF:

Prepare for a career in health information management and medical billing and insurance processing with Green’s UNDERSTANDING HEALTH INSURANCE, 14E. This comprehensive, inviting book presents the latest code sets and guidelines. Examine today’s most important topics, such as managed care, legal and regulatory issues, coding systems and compliance, reimbursement methods, clinical documentation improvement, coding for medical necessity, and common health insurance plans. Updates introduce new legislation that impacts health care, including changes to the Affordable Care Act (Obamacare); ICD-10-CM, CPT, and HCPCS level II coding; revenue cycle management; and individual health plans. Workbook exercises provide application-based assignments and case studies, as well as CMRS, CPC-P, and CPB mock exams.

Michelle Green has been a SUNY Distinguished Teaching Professor in the health information technology department at Mohawk Valley Community College in Utica, New York, since 2017. She was the SUNY Distinguished Teaching Professor in the physical and life sciences department at the State University of New York College of Technology for more than 30 years. She has authored three popular textbooks related to coding, revenue management and health information management. An active member of the American Academy of Professional Coders and American Health Information Management Association, Green has been recognized for her excellence in teaching as well as her significant contributions to the health information management profession. Her numerous accolades include 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 AHIMA’s FORE Triumph Educator Award. In addition, she is a Registered Health Information Administrator, a fellow of the American Health Information Management Association and a Certified Professional Coder. She earned an MPS from Alfred University and a Bachelor of Science from Daemen College.

Features of Understanding Health Insurance: A Guide to Billing and Reimbursement 14th Edition PDF

Here’s a quick overview of the essential features of this book:

The book provides a strong and detailed look at the main insurance companies in the USA – Medicare, Medicaid, and BC/BS. The product has MindTap which allows students many more options than before. In addition to the electronic grade book in MindTap, there is also the SimClaim assignments that students can accomplish through the web…The fact that it is all web based is a MAJOR PLUS!

Chapter 11, Essential CMS-1500 Claim Instructions: Very detailed explanation. Lesson is timed appropriately. Good mention of optical scanning guidelines (and) national provider identifier. This chapter provides good detail on all portions of the form. Students retain the information and are able to immediately apply it.

Table of Contents

Below is the complete table of contents offered inside Understanding Health Insurance 14th Edition PDF:

  1. Table of Contents
  2. Preface
  3. About the Author
  4. Reviewers
  5. Acknowledgments
  6. How to Use This Text
  7. How to Use SimClaim CMS-1500 Software
  8. Chapter 1: Health Insurance Specialist Career
  9. Introduction
  10. Health Insurance Overview
  11. Health Insurance Career Opportunities
  12. Education and Training
  13. Job Responsibilities
  14. Professionalism
  15. Chapter 2: Introduction to Health Insurance
  16. Introduction
  17. What Is Health Insurance?
  18. Health Insurance Coverage Statistics
  19. Major Developments in Health Insurance
  20. Health Care Documentation
  21. Electronic Health Record (EHR)
  22. Health Insurance Marketplace
  23. Chapter 3: Managed Health Care
  24. Introduction
  25. History of Managed Health Care
  26. Managed Care Organizations
  27. Managed Care Models
  28. Consumer-Directed Health Plans
  29. Accreditation of Managed Care Organizations
  30. Effects of Managed Care on a Physician’s Practice
  31. Chapter 4: Revenue Cycle Management
  32. Introduction
  33. Revenue Cycle Management
  34. Encounter Form
  35. Chargemaster
  36. Processing an Insurance Claim
  37. Managing New Patients
  38. Managing Established Patients
  39. Managing Office Insurance Finances
  40. Insurance Claim Revenue Cycle
  41. Maintaining Insurance Claim Files
  42. Credit and Collections
  43. Chapter 5: Legal and Regulatory Issues
  44. Introduction
  45. Introduction to Legal and Regulatory Considerations
  46. Federal Laws and Events That Affect Health Care
  47. Retention of Records
  48. Health Insurance Portability and Accountability Act (HIPAA)
  49. Chapter 6: ICD-10-CM Coding
  50. Introduction
  51. ICD-9-CM Legacy Coding System
  52. Overview of ICD-10-CM and ICD-10-PCS
  53. ICD-10-CM Coding Conventions
  54. ICD-10-CM Index to Diseases and Injuries
  55. ICD-10-CM Tabular List of Diseases and Injuries
  56. Official Guidelines for Coding and Reporting
  57. Chapter 7: CPT Coding
  58. Introduction
  59. Overview of CPT
  60. CPT Sections, Subsections,Categories, and Subcategories
  61. CPT Index
  62. CPT Modifiers
  63. Coding Procedures and Services
  64. Evaluation and Management Section
  65. Anesthesia Section
  66. Surgery Section
  67. Radiology Section
  68. Pathology and Laboratory Section
  69. Medicine Section
  70. Chapter 8: HCPCS Level II Coding
  71. Introduction
  72. Overview of HCPCS
  73. HCPCS Level II National Codes
  74. Determining Payer Responsibility
  75. Assigning HCPCS Level II Codes
  76. Chapter 9: CMS Reimbursement Methodologies
  77. Introduction
  78. Historical Perspective of CMS Reimbursement Systems
  79. CMS Payment Systems
  80. Ambulance Fee Schedule
  81. Ambulatory Surgical Center Payment Rates
  82. Clinical Laboratory Fee Schedule
  83. Durable Medical Equipment, Prosthetics/Orthotics, and Supplies Fee Schedule
  84. End-Stage Renal Disease (ESRD) Composite Rate Payment System
  85. Federally Qualified HealthCenters Prospective Payment System (FQHC PPS)
  86. Home Health Prospective Payment System
  87. Hospital Inpatient Prospective Payment System
  88. Hospital Outpatient Prospective Payment System
  89. Inpatient Psychiatric Facility Prospective Payment System
  90. Inpatient Rehabilitation Facility Prospective Payment System
  91. Long-Term (Acute) Care Hospital Prospective Payment System
  92. Skilled Nursing Facility Prospective Payment System
  93. Medicare Physician Fee Schedule
  94. Chapter 10: Coding Compliance, Clinical Documentation Improvement, and Coding for Medical Necessity
  95. Introduction
  96. Coding Compliance
  97. Clinical Documentation Improvement
  98. Coding for Medical Necessity
  99. Chapter 11: CMS-1500 and UB-Claims
  100. Introduction
  101. General Claims Information
  102. Optical Scanning Guidelines
  103. Entering Patient and Policyholder Names
  104. Entering Provider Names
  105. Entering Mailing Addresses and Telephone Numbers
  106. Recovery of Funds from Responsible Payers
  107. National Provider Identifier (NPI)
  108. Assignment of Benefits versus Accept Assignment
  109. Reporting Diagnoses: ICD-10-CM Codes
  110. Reporting Procedures and Services: HCPCS Level II and CPT Codes
  111. National Standard Employer Identifier
  112. Reporting the Billing Entity
  113. Processing Secondary CMS-1500 Claims
  114. Common Errors That Delay CMS-1500 Claims Processing
  115. Final Steps in Processing CMS-1500 Claims
  116. Maintaining CMS-1500 Insurance Claim Files for the Medical Practice
  117. UB-04 Claim
  118. Chapter 12: Commercial Insurance
  119. Introduction
  120. Commercial Health Insurance
  121. Automobile, Disability, and Liability Insurance
  122. Commercial Claims
  123. Commercial Secondary Coverage
  124. Commercial Group Health Plan Coverage
  125. Chapter 13: BlueCross BlueShield
  126. Introduction
  127. History of Bluecross and Blueshield
  128. Bluecross Blueshield Insurance
  129. Billing Notes
  130. Claims Instructions
  131. Bluecross Blueshield Secondary Coverage
  132. Chapter 14: Medicare
  133. Introduction
  134. Medicare Eligibility
  135. Medicare Enrollment
  136. Medicare Part A
  137. Medicare Part B
  138. Medicare Part C
  139. Medicare Part D
  140. Other Medicare Health Plans
  141. Employer and Union Health Plans
  142. Medigap
  143. Participating Providers
  144. Nonparticipating Providers
  145. Mandatory Claims Submission
  146. Private Contracting
  147. Advance Beneficiary Notice of Noncoverage
  148. Experimental and Investigational Procedures
  149. Medicare as Primary Payer
  150. Medicare as Secondary Payer
  151. Medicare Summary Notice
  152. Billing Notes
  153. Claims Instructions
  154. Medicare and Medigap Claims
  155. Medicare-Medicaid (Medi-Medi) Crossover Claims
  156. Medicare as Secondary Payer Claims
  157. Roster Billing for Mass Vaccination Programs
  158. Chapter 15: Medicaid
  159. Introduction
  160. Medicaid Eligibility
  161. Medicaid-Covered Services
  162. Payment for Medicaid Services
  163. Billing Notes
  164. Claims Instructions
  165. Medicaid as Secondary Payer Claims
  166. Mother/Baby Claims
  167. SCHIP Claims
  168. Chapter 16: TRICARE
  169. Introduction
  170. TRICARE Background
  171. TRICARE Administration
  172. CHAMPVA
  173. TRICARE Options
  174. TRICARE Special Programs
  175. TRICARE Supplemental Plans
  176. Billing Notes
  177. Claims Instructions
  178. TRICARE as Secondary Payer
  179. TRICARE and Supplemental Coverage
  180. Chapter 17: Workers’ Compensation
  181. Introduction
  182. Federal Workers’ Compensation Programs
  183. State Workers’ Compensation Programs
  184. Eligibility for Workers’ Compensation Coverage
  185. Classification of Workers’ Compensation Cases
  186. Special Handling of Workers’ Compensation Cases
  187. Workers’ Compensation and Managed Care
  188. First Report of Injury Form
  189. Progress Reports
  190. Appeals and Adjudication
  191. Fraud and Abuse
  192. Billing Notes
  193. Claims Instructions
  194. Appendix I: Forms
  195. Appendix II: Dental Claims Processing
  196. Appendix III: Abbreviations
  197. Bibliography
  198. Glossary
  199. Index

Understanding Health Insurance 14th Edition PDF Free Download

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