Understanding Health Insurance: A Guide to Billing and Reimbursement, 2023 Edition
18th Edition
Published on 3. August 2023
Book
Paperback/Softback
704 pages
978-0-357-76406-0 (ISBN)
Description
Strengthen your skills and develop a solid foundation for professional success with Green's UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2023 Edition. This reader-friendly, comprehensive resource provides a practical, up-to-date guide to current medical code sets and coding guidelines, preparing you to assign ICD-10-CM, CPT (R) and HCPCS Level II 2023 codes; complete health insurance claims; and master key revenue management concepts. You'll focus on 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. The current edition introduces the MIPS Value Pathways; explains major changes for selecting codes in the CPT 2023 evaluation and management section; and clarifies key health insurance concepts such as risk adjustments, hierarchical condition category coding, patient portals, balance billing, coordination of benefits, third-party administrators, Medicare appeals process and whistleblowers. In addition, a helpful workbook provides hands-on assignments and case studies, while MindTap online resources offer interactive practice in completing CMS-1500 claims and assigning codes.
More details
Edition
18th edition
Language
English
Place of publication
Clifton Park
United States
Publishing group
Cengage Learning, Inc
Target group
College/higher education
Dimensions
Height: 30 mm
Width: 215 mm
Thickness: 274 mm
Weight
1430 gr
ISBN-13
978-0-357-76406-0 (9780357764060)
Copyright in bibliographic data and cover images is held by Nielsen Book Services Limited or by the publishers or by their respective licensors: all rights reserved.
Schweitzer Classification
Other editions
New editions
Book
01/2024
19th Edition
Delmar Cengage Learning
€260.50
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Previous edition
Book
01/2022
17th Edition
Delmar Cengage Learning
€173.32
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Person
Michelle Green has served as a full-time or adjunct faculty member since 2017. During Spring 2023, Green was named interim Program Director in the Health Information Technology department at Mohawk Valley Community College in Utica, New York. She was the SUNY Distinguished Teaching Professor in the Physical and Life Sciences department at the State University of New York College of Technology at Alfred for over 30 years. She has authored three popular textbooks related to coding, revenue management and health information management. An active member of the AAPC 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, AHIMA's FORE Triumph Educator Award and NYHIMA's 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.
Content
1. Health Insurance Specialist Career.
2. Introduction to Health Insurance and Managed Care.
3. Introduction to Revenue Management.
4. Revenue Management: Insurance Claims, Denied Claims and Appeals and Credit and Collections.
5. Legal Aspects of Health Insurance and Reimbursement.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding Compliance, Clinical Documentation Improvement and Coding for Medical Necessity.
11. CMS-1500 and UB-04 Claims.
12. Commercial Insurance.
13. BlueCross BlueShield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers' Compensation.
Appendices.
Bibliography.
Glossary.
Index.
2. Introduction to Health Insurance and Managed Care.
3. Introduction to Revenue Management.
4. Revenue Management: Insurance Claims, Denied Claims and Appeals and Credit and Collections.
5. Legal Aspects of Health Insurance and Reimbursement.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding Compliance, Clinical Documentation Improvement and Coding for Medical Necessity.
11. CMS-1500 and UB-04 Claims.
12. Commercial Insurance.
13. BlueCross BlueShield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers' Compensation.
Appendices.
Bibliography.
Glossary.
Index.