Beik’s Health Insurance Today A Practical Approach 8th Edition By Julie Pepper
eBook[PDF]

Beik’s Health Insurance Today A Practical Approach 8th Edition By Julie Pepper

$30.00
✓ Secure checkout
✓ Instant digital download
✓ PDF document

Document details

Pages
764
File size
11.69 MB
Format
Digital PDF
Course
Medicine
Category
eBook[PDF]
About this ebook
Beik's Health Insurance Today: A Practical Approach (8th Edition) by Julie Pepper covers the fundamental billing, coding, and administrative concepts required to navigate the health insurance system. The textbook is structured into clear chronological sections that guide you from the basics of healthcare coverage through complex claims processing and medical reimbursement workflows. [1, 2]
Core Topics Covered
Unit 1: Foundations of Health Insurance
  • Introduction to Health Insurance: History, terminology, and foundational structures of the medical billing industry.
  • Ethical and Legal Issues: Focus on compliance, fraud prevention, and government guidelines.
  • HIPAA Regulations: Privacy standards, security rules, and electronic transaction requirements. [1, 2]
Unit 2: Health Insurance Basics & Carriers
  • Reimbursement Models: Fee-for-service, capitation, and value-based payment architectures.
  • Managed Care Plans: Operations of HMOs, PPOs, and point-of-service options.
  • Medicare: Structure, enrollment, coverage parts (A, B, C, and D), and supplemental plans.
  • Medicaid: Eligibility mandates, state vs. federal funding, and coverage guidelines.
  • Military Carriers: Guidelines for TRICARE and CHAMPVA programs.
  • Miscellaneous Carriers: Workers’ Compensation systems and temporary disability insurance policies. [1]
Unit 3: Medical Coding and Claims Submission
  • Claim Submission Methods: Workflow variations between electronic data interchange (EDI) and paper filings.
  • Diagnostic Coding: ICD-10-CM guidelines and their clinical applications for statistical validation.
  • Procedural Coding: Utilizing CPT, Evaluation and Management (E/M) modifiers, and HCPCS Level II codes.
  • Claims Management: Tracking claims, clearinghouse workflows, and managing standard CMS-1500 and UB-04 forms. [1, 2, 3]
Unit 4: Advanced Administrative Application
  • Computers in Health Insurance: Electronic Health Record (EHR) integration and practice management software.
  • Reimbursement Procedures: Posting payments, deciphering Remittance Advices (RAs), and managing patient collections.
  • Hospital Billing: Complexities specific to institutional facilities using UB-04 formatting frameworks. [1, 2, 3, 4]
Features New to the 8th Edition
The current 8th edition adds highly specific contemporary topics reflecting the shifting modern healthcare landscape: [1]
  • Cybersecurity Compliance: Safeguarding digital infrastructure and preventing healthcare data breaches.
  • COVID-19 Impacts: Alterations made to employment verification, testing reimbursement protocols, and emergency medical coding.
  • Medical Crowdfunding: Legislative and accounting impacts of patient reliance on crowdfunding sites for out-of-pocket costs.
  • Cost/Value Calculators: Practical training with Geographic Practice Cost Indexes (GPCI) and Resource-Based Relative Value Scale (RBRVS) systems.

File included

PDF
tmpphp8QlxWi 11.69 MB

Topics

Advanced Administrative Application Claim Submission Methods: Workflow variations between electronic data interchange (EDI) and paper filings Claims Management: Tracking claims clearinghouse workflows and managing standard CMS-1500 and UB-04 forms Computers in Health Insurance: Electronic Health Record (EHR) management software. Reimbursement Procedures: Posting payments deciphering Remittance Advices (RAs) Cost/Value Calculators: Practical training with Geographic Practice Cost Indexes (GPCI) COVID-19 Impacts: Alterations made to employment verification testing reimbursement protocols and emergency medical coding Cybersecurity Compliance: Safeguarding digital infrastructure and preventing healthcare data breaches Diagnostic Coding: ICD-10-CM guidelines and their clinical applications for statistical validation Ethical and Legal Issues: compliance fraud prevention and government guidelines Foundations of Health Insurance Health Insurance Basics & Carriers HIPAA Regulations: Privacy standards security rules and electronic transaction requirements Hospital Billing: Complexities specific to institutional facilities using UB-04 frameworks Introduction to Health Insurance: History terminology and foundational structures of the medical billing industry ISBN-13: 978-0323884006 ISBN-13: 978-0323934107 ISBN-13: 978-0443112225 Managed Care Plans: Operations of HMOs PPOs and point-of-service options Medicaid: Eligibility mandates state vs. federal funding and coverage guidelines Medical Coding and Claims Submission Medical Crowdfunding: Legislative and accounting impacts of patient reliance on crowdfunding sites for out-of-pocket costs Medicare: Structure enrollment coverage parts (A B C and D) and supplemental plans Military Carriers: Guidelines for TRICARE and CHAMPVA programs Miscellaneous Carriers: Workers’ Compensation systems and temporary disability insurance policies Procedural Coding: CPT Evaluation and Management (E/M) modifiers and HCPCS Level II codes Reimbursement Models: Fee-for-service capitation and value-based payment architectures Resource-Based Relative Value Scale (RBRVS) systems
Related ebooks