Comprehensive Health Insurance Billing, Coding, and Reimbursement 3rd Edition By Deborah Vines, Ann Braceland, Elizabeth Rollins, Susan Miller
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Comprehensive Health Insurance Billing, Coding, and Reimbursement 3rd Edition By Deborah Vines, Ann Braceland, Elizabeth Rollins, Susan Miller

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Pages
795
File size
33.64 MB
Format
Digital PDF
Course
Business
Category
eBook[PDF]
About this ebook
The Comprehensive Health Insurance: Billing, Coding, and Reimbursement (3rd Edition) by Deborah Vines, Ann Braceland, Elizabeth Rollins, and Susan Miller is a step-by-step guide designed to teach the medical administrative tasks necessary for workplace readiness in healthcare settings. [1]
The book covers 17 core chapters organized around the interconnected lifecycle of insurance policy, medical coding, billing, and financial reimbursement: [1, 2]
1. Foundations of Health Insurance & Careers
  • Introduction to Professional Billing and Coding: Overview of the career opportunities, roles of health insurance specialists, medical billers, and centralized billing office (CBO) setups. [1, 2, 3]
  • Managed Care Systems: Comprehensive breakdown of healthcare delivery monitoring, contracting with insurance payers, and different care delivery models. [1, 2]
2. Regulatory Compliance & Industry Trends
  • HIPAA Compliance: Dedicated focus on healthcare privacy, security laws, and electronic health transaction standards. [1, 2]
  • The Affordable Care Act (ACA): Detailed assessment of the legal and structural ramifications of the ACA on patient coverage and medical claims. [1]
  • Modern Healthcare Trends: Exploration of care delivery models, concierge medicine, and telemedicine infrastructure as evolving treatment pathways. [1]
3. Medical Coding Systems
  • ICD-10-CM Diagnostic Coding: Utilizing international classification systems to determine and translate patient medical conditions.
  • CPT (Current Procedural Terminology) Coding: Translating outpatient procedures and evaluations performed by medical staff.
  • HCPCS Level II Coding: Reporting medical equipment, supplies, and non-physician services. [1, 2, 3]
4. The Billing Lifecycle & Claims Management
  • Insurance Claim Process: Moving claims through their lifecycle, including verification of patient benefits, collecting copayments, and preparing standard forms like the CMS-1500.
  • Electronic Health Records (EHR): Navigating automated and non-automated administrative environments.
  • Secondary Claims & Coordination of Benefits: Handling claims submission when a patient is covered under multiple policies. [1, 2, 3, 4, 5]
5. Government Programs & Reimbursement
  • Medicare & Medicaid: Step-by-step look at government-funded medical billing, calculating Medicare percentages, and strict state/federal compliance guidelines.
  • Payment Posting & Financial Auditing: Processing explanations of benefits (EOBs), matching payments, identifying discrepancies, and financial accounting within patient portfolios.
  • Appealing Denials and Audits: Re-evaluating rejected or denied claims, handling refunds, and understanding client/payer compliance metrics. [1, 2, 3, 4, 5]

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Topics

Appealing Denials and Audits Billing Lifecycle & Claims Management CPT Current Procedural Terminology Coding Electronic Health Records HER Foundations of Health Insurance & Careers Government Programs & Reimbursement HCPCS Level II Coding HIPAA Compliance Dedicated focus on healthcare privacy ICD-10-CM Diagnostic Coding Insurance Claim Process ISBN-13: 978-0134458779 ISBN-13: 978-0134458878 or 978-0136873716 ISBN-13: 978-0134868943 Managed Care Systems Medical Coding Systems Medicare & Medicaid Modern Healthcare Trends Payment Posting & Financial Auditing Professional Billing and Coding Regulatory Compliance & Industry Trends Secondary Claims & Coordination of Benefits The Affordable Care Act (ACA)
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