Guide To Medical Billing
Published on 23. May 2005
Book
Paperback/Softback
480 pages
978-0-13-171849-4 (ISBN)
Description
Ideal for two-year and career college program in medical billing and coding.
Practical Guide to what students need to succeed in the job including professionalism, billing and coding skills, and general studies. Written with one goal - to ensure students succeed the first and every day as a medical biller. It is ideal for learning how to perform as a medical biller/coder.
Practical Guide to what students need to succeed in the job including professionalism, billing and coding skills, and general studies. Written with one goal - to ensure students succeed the first and every day as a medical biller. It is ideal for learning how to perform as a medical biller/coder.
More details
Language
English
Place of publication
United States
Publishing group
Pearson Education (US)
Target group
Professional and scholarly
Weight
939 gr
ISBN-13
978-0-13-171849-4 (9780131718494)
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
Content
(NOTE: Each chapter contains a Summary, Assignments, Questions for Review , and Honors Certification (TM))
1. Introduction.
The Historical Perspective
Job Roles and Duties
The Medical Team
Types of Healthcare Settings
Technology and the Medical Biller
Attitudes that Make a Successful
Medical Biller
Workplace Professionalism
Interpersonal Skills
Professional Appearance
Stress
Pre-Vacation Work Planning
Detail Orientation
Certification Programs for Medical Billers
Exercises 1 - 1 through 1 - 3
2. Time Management and Prioritizing.
Prioritization
Pressure Projects
Time Management
Counting Time Backwards
Overlapping Projects
Exercises 2 - 1 through 2 - 2
3. Legal Issues.
Privacy Guidelines
Fraud
HIPAA and Fraud and Abuse
Embezzlement
Disclaimers
Legal Damages
Medical Ethics
Subpoenas
Instances in Which the Patient Should
Be Notified and the File Notated
4. Clinical Records Management.
Medical Charts
Filing the Chart
Medical Documentation Rules
Signature Cards
Retention of Records
Storing Medical Records
Electronic Medical Charting
Computerized Files
Record Transfers
5. Medical Documentation Forms.
Patient Information Sheet
Release of Information Form
Assignment of Benefits Form
Patient History Form
Insurance Verification
Additional Suggestions
Exercise 5 - 1
6. Contract Interpretation.
Blue Cross/ Blue Shield
Contract Provisions
Contract Benefits
Exclusions
Allowed Amounts
Pre-Certification of Inpatient Admissions
Utilization Review
Second Surgical Opinion Consultations
Exercises 6 - 1 through 6 - 5
Sample Insurance Contract
7. Medicare.
TEFRA/DEFRA
Medicare Eligibility
Providers of Service
The Two Parts of Medicare
Approved or Reasonable Charges
Billing Medicare Services
Assignment of Benefits
Coordinating Medicare w/Other Insurance
Estimating Medicare Coverage
Diagnosis-Related Group Billing
Medicare Denials
Medicare Advance Notice
The Medicare Appeals Process
Medical Fraud and Abuse
Medicare Supplement
Medicare and Veterans
Medicare and Managed Care
Medicare Notice of Non-Coverage
Medicare Timeliness Reports
Exercise 7 - 1
8. Medicaid.
Medicaid Billing Procedures
Treatment Authorization Request
Reimbursement from Medicaid
9. Workers' Compensation.
Employee Activities
Time Limits
Types of Claims
Benefits of Workers' Compensation
Workers' Compensation Reform
Medical Service Order
Patient Records
Doctor's First Report
Subsequent Progress Reports
Physician's Final Report
Delay of Adjudication
Billing for Workers' Compensation
Delinquent Claims
Fraud and Abuse
Third Party Liability
Liens
Reversals
Exercise 9-1
10. Managed Care.
Rising Health Care Costs
Decreasing Costs
Managed Care
HMO Coverage
Preferred Provider Organizations
Billing Managed Care
Groups/IPAs
Capitation Payments
Patient Charts
HMO Appointment Scheduling
Authorizations, Referrals, and Second Opinions
Denial of Service to Members
Member Grievances and Complaints
Transfers
Disenrollment
Continuing Care
Miscellaneous Services
Facility Requirements
Sanctions
Claim Payments
11. Miscellaneous Billing Procedures.
Billing for Service
Determining the Proper Billing Amount
Billing Forms
Additional Suggestions
Billing Tips/ Issues
Special Services
Maximum Reimbursement Tips
Collecting the Patient Portion
Patient Claim form
Coordination of Benefits
COB With Health Maintenance Organizations
TRICARE
Exercise 11 - 1
12. Patient Accounting.
Accounts Payable/ Receivable
The Ledger Card
Insurance Payments
Posting Payments
Balance Billing
Follow-Ups
Collections
Collections Procedures
Small Claims Court
Exercise 12 - 1
13. Office Accounting.
Petty Cash
Office Reports
14. Terminology.
Insurance Terminology
Provider Abbreviations
Medical Abbreviations
Medical Symbols
Exercises 14 - 1 through 14 - 4
15. Reference Books.
ICD-9
CPT (R)/RVS
HCPCS
Physicians' Desk Reference
Medical Dictionary
Merck Manual
Exercises 15 - 1 through 15 - 4
16. ICD-9.
History of the ICD-9
Contents of the ICD-9
How to Use the ICD-9
General Guidelines
Main Terms
Exceptions
V Codes238
E Codes
Signs and Symbols Used in the ICD-D
Billing Tips
ICD-10
Exercises 16 - 1 through 16 - 5
17. CPT (R) Coding.
Using the CPT (R)
Semicolons in the CPT (R)
Signs and Symbols Used in the CPT (R)
Using the CPT (R) Index
Modifiers
Unlisted Codes
Evaluation and Management Codes
Anesthesia
Surgery
Radiology/X-ray
Pathology/Laboratory
Medicine
Billing Tips
Exercises 17 - 1 through 17 - 10
18. HCPCS Coding.
General Information
Coding Using the HCPCS Manual
Sections of the HCPCS Manual
Transportation Services
Medical and Surgical Supplies
Miscellaneous and Experimental
Enteral and Parenteral Therapy
Temporary Hospital Outpatient PPS
Dental Procedures
Durable Medical Equipment
Procedures and Professional Services
Rehabilitative Services
Drugs Administered Other than Oral Method
Immunosuppressive Drugs
Chemotherapy Drugs
Temporary Codes for DMERCs
Orthotic Procedures
Prosthetic Procedures
Medical Services
Pathology/Laboratory
Temporary Codes
Diagnostic Radiology Services
Private Payer Codes
State Medicaid Agency Codes
Vision Services
Hearing Services
Modifiers
Exercises 18 - 1 through 18 - 2
19. Medications and the PDR.
Generic vs. Brand Name Drugs
Service Plans
Physicians' Desk Reference
Definitions
Symbols
Exercises 19 - 1 through 19 - 3
20. CMS-1500.
Item # and Item Name/ Description
Item 24B, Place of Service
Tips on Completing the CMS-1500
Exercise 20 - 1
21. UB-92 Hospital Billing Form.
Item# and Item Name/Description
Item 4, Type of Bill
Item 19, Type of Admission
Item 20, Source of Admission
Item 22, Patient Status
Items 24-30, Condition Codes
Items 32-35, Occurrence Codes
Item 33, Occurrence
Span Codes and Dates
Items 39-41, Value Codes and Amounts
Item 42, Hospital Revenue Codes
Item 53, Assignment of Benefits
Item 59, Relationship
Item 64, Employment Status Code
Exercise 21 - 1
Appendix 21 - 1 Hospital Revenue Codes
22.HospitalBilling.
Which Claim Form Is Right?
Charge Description Masters
Entering Charges
How Billing Affects Other Departments
Preauthorization, Pre-certifications and Utilization Reviews
Ambulatory Surgical Centers
23. Medical Reports.
Abstracting From Medical Records
Triage Reports
Operative Reports
Diagnostic Testing Reports
Medical History and Physical
Examination Reports
Exercises 23 - 1 through 23 - 20
Appendix 23 - 1
24. Claims Submission Process.
Clean Claims
Incomplete Data Master List
Submission Time Limits
Optical Scanning Guidelines
Submitting the Claims
Electronic Claims Submission
Billing Reports
Tracer Claims/ Delinquent Claims
Denied Claims
Re-submissions
Adjusted Claims
Appeals
Balance Billing Patients for Downcoded or Denied Claims
State Insurance Commissioner
25. Calculator Basics.
Key Descriptions
Printer Tape Symbols
Exercises 25 - 1 through 25 - 4
26. General Office Procedures.
Mail
Ordering Supplies
Office Machines
Tickler Files
27. Customer Service/Patient Relations.
Understanding Needs
Attitudes and Feelings
First Impressions and Image
Characteristics of Client Relations
Customer Service Job Functions
The Art of Listening
Handling Difficult Clients
Handling Unwanted Callers
Professionalism
Telephone Techniques
Phone Calls
Telephone Etiquette
Maintaining an Appointment Calendar
Exercises 27 - 1 through 27 - 7
28. Computer Basics.
The Computer
The Monitor
The Keyboard
Frustration Free Computing
Computer Terms
29. Correspondence for the Medical Office.
The Opening
The Body
The Closing
Correspondence Containing Negative Content
Format of the Letter
Memos
Postal Abbreviations
Exercises 29 - 1 through 29 - 2
30. Job Search Preparation.
Job Search Objectives
Uniqueness
Target Audience
Build Your Database
The Resume
The Cover Letter
Marketing Yourself
The Job Interview
Getting Paid What You Are Worth
Exercise 30 - 1
Resume Questionnaire
Sample Resume # 1
Sample Cover Letter # 1
Sample Resume # 2
Sample Resume # 3
1. Introduction.
The Historical Perspective
Job Roles and Duties
The Medical Team
Types of Healthcare Settings
Technology and the Medical Biller
Attitudes that Make a Successful
Medical Biller
Workplace Professionalism
Interpersonal Skills
Professional Appearance
Stress
Pre-Vacation Work Planning
Detail Orientation
Certification Programs for Medical Billers
Exercises 1 - 1 through 1 - 3
2. Time Management and Prioritizing.
Prioritization
Pressure Projects
Time Management
Counting Time Backwards
Overlapping Projects
Exercises 2 - 1 through 2 - 2
3. Legal Issues.
Privacy Guidelines
Fraud
HIPAA and Fraud and Abuse
Embezzlement
Disclaimers
Legal Damages
Medical Ethics
Subpoenas
Instances in Which the Patient Should
Be Notified and the File Notated
4. Clinical Records Management.
Medical Charts
Filing the Chart
Medical Documentation Rules
Signature Cards
Retention of Records
Storing Medical Records
Electronic Medical Charting
Computerized Files
Record Transfers
5. Medical Documentation Forms.
Patient Information Sheet
Release of Information Form
Assignment of Benefits Form
Patient History Form
Insurance Verification
Additional Suggestions
Exercise 5 - 1
6. Contract Interpretation.
Blue Cross/ Blue Shield
Contract Provisions
Contract Benefits
Exclusions
Allowed Amounts
Pre-Certification of Inpatient Admissions
Utilization Review
Second Surgical Opinion Consultations
Exercises 6 - 1 through 6 - 5
Sample Insurance Contract
7. Medicare.
TEFRA/DEFRA
Medicare Eligibility
Providers of Service
The Two Parts of Medicare
Approved or Reasonable Charges
Billing Medicare Services
Assignment of Benefits
Coordinating Medicare w/Other Insurance
Estimating Medicare Coverage
Diagnosis-Related Group Billing
Medicare Denials
Medicare Advance Notice
The Medicare Appeals Process
Medical Fraud and Abuse
Medicare Supplement
Medicare and Veterans
Medicare and Managed Care
Medicare Notice of Non-Coverage
Medicare Timeliness Reports
Exercise 7 - 1
8. Medicaid.
Medicaid Billing Procedures
Treatment Authorization Request
Reimbursement from Medicaid
9. Workers' Compensation.
Employee Activities
Time Limits
Types of Claims
Benefits of Workers' Compensation
Workers' Compensation Reform
Medical Service Order
Patient Records
Doctor's First Report
Subsequent Progress Reports
Physician's Final Report
Delay of Adjudication
Billing for Workers' Compensation
Delinquent Claims
Fraud and Abuse
Third Party Liability
Liens
Reversals
Exercise 9-1
10. Managed Care.
Rising Health Care Costs
Decreasing Costs
Managed Care
HMO Coverage
Preferred Provider Organizations
Billing Managed Care
Groups/IPAs
Capitation Payments
Patient Charts
HMO Appointment Scheduling
Authorizations, Referrals, and Second Opinions
Denial of Service to Members
Member Grievances and Complaints
Transfers
Disenrollment
Continuing Care
Miscellaneous Services
Facility Requirements
Sanctions
Claim Payments
11. Miscellaneous Billing Procedures.
Billing for Service
Determining the Proper Billing Amount
Billing Forms
Additional Suggestions
Billing Tips/ Issues
Special Services
Maximum Reimbursement Tips
Collecting the Patient Portion
Patient Claim form
Coordination of Benefits
COB With Health Maintenance Organizations
TRICARE
Exercise 11 - 1
12. Patient Accounting.
Accounts Payable/ Receivable
The Ledger Card
Insurance Payments
Posting Payments
Balance Billing
Follow-Ups
Collections
Collections Procedures
Small Claims Court
Exercise 12 - 1
13. Office Accounting.
Petty Cash
Office Reports
14. Terminology.
Insurance Terminology
Provider Abbreviations
Medical Abbreviations
Medical Symbols
Exercises 14 - 1 through 14 - 4
15. Reference Books.
ICD-9
CPT (R)/RVS
HCPCS
Physicians' Desk Reference
Medical Dictionary
Merck Manual
Exercises 15 - 1 through 15 - 4
16. ICD-9.
History of the ICD-9
Contents of the ICD-9
How to Use the ICD-9
General Guidelines
Main Terms
Exceptions
V Codes238
E Codes
Signs and Symbols Used in the ICD-D
Billing Tips
ICD-10
Exercises 16 - 1 through 16 - 5
17. CPT (R) Coding.
Using the CPT (R)
Semicolons in the CPT (R)
Signs and Symbols Used in the CPT (R)
Using the CPT (R) Index
Modifiers
Unlisted Codes
Evaluation and Management Codes
Anesthesia
Surgery
Radiology/X-ray
Pathology/Laboratory
Medicine
Billing Tips
Exercises 17 - 1 through 17 - 10
18. HCPCS Coding.
General Information
Coding Using the HCPCS Manual
Sections of the HCPCS Manual
Transportation Services
Medical and Surgical Supplies
Miscellaneous and Experimental
Enteral and Parenteral Therapy
Temporary Hospital Outpatient PPS
Dental Procedures
Durable Medical Equipment
Procedures and Professional Services
Rehabilitative Services
Drugs Administered Other than Oral Method
Immunosuppressive Drugs
Chemotherapy Drugs
Temporary Codes for DMERCs
Orthotic Procedures
Prosthetic Procedures
Medical Services
Pathology/Laboratory
Temporary Codes
Diagnostic Radiology Services
Private Payer Codes
State Medicaid Agency Codes
Vision Services
Hearing Services
Modifiers
Exercises 18 - 1 through 18 - 2
19. Medications and the PDR.
Generic vs. Brand Name Drugs
Service Plans
Physicians' Desk Reference
Definitions
Symbols
Exercises 19 - 1 through 19 - 3
20. CMS-1500.
Item # and Item Name/ Description
Item 24B, Place of Service
Tips on Completing the CMS-1500
Exercise 20 - 1
21. UB-92 Hospital Billing Form.
Item# and Item Name/Description
Item 4, Type of Bill
Item 19, Type of Admission
Item 20, Source of Admission
Item 22, Patient Status
Items 24-30, Condition Codes
Items 32-35, Occurrence Codes
Item 33, Occurrence
Span Codes and Dates
Items 39-41, Value Codes and Amounts
Item 42, Hospital Revenue Codes
Item 53, Assignment of Benefits
Item 59, Relationship
Item 64, Employment Status Code
Exercise 21 - 1
Appendix 21 - 1 Hospital Revenue Codes
22.HospitalBilling.
Which Claim Form Is Right?
Charge Description Masters
Entering Charges
How Billing Affects Other Departments
Preauthorization, Pre-certifications and Utilization Reviews
Ambulatory Surgical Centers
23. Medical Reports.
Abstracting From Medical Records
Triage Reports
Operative Reports
Diagnostic Testing Reports
Medical History and Physical
Examination Reports
Exercises 23 - 1 through 23 - 20
Appendix 23 - 1
24. Claims Submission Process.
Clean Claims
Incomplete Data Master List
Submission Time Limits
Optical Scanning Guidelines
Submitting the Claims
Electronic Claims Submission
Billing Reports
Tracer Claims/ Delinquent Claims
Denied Claims
Re-submissions
Adjusted Claims
Appeals
Balance Billing Patients for Downcoded or Denied Claims
State Insurance Commissioner
25. Calculator Basics.
Key Descriptions
Printer Tape Symbols
Exercises 25 - 1 through 25 - 4
26. General Office Procedures.
Ordering Supplies
Office Machines
Tickler Files
27. Customer Service/Patient Relations.
Understanding Needs
Attitudes and Feelings
First Impressions and Image
Characteristics of Client Relations
Customer Service Job Functions
The Art of Listening
Handling Difficult Clients
Handling Unwanted Callers
Professionalism
Telephone Techniques
Phone Calls
Telephone Etiquette
Maintaining an Appointment Calendar
Exercises 27 - 1 through 27 - 7
28. Computer Basics.
The Computer
The Monitor
The Keyboard
Frustration Free Computing
Computer Terms
29. Correspondence for the Medical Office.
The Opening
The Body
The Closing
Correspondence Containing Negative Content
Format of the Letter
Memos
Postal Abbreviations
Exercises 29 - 1 through 29 - 2
30. Job Search Preparation.
Job Search Objectives
Uniqueness
Target Audience
Build Your Database
The Resume
The Cover Letter
Marketing Yourself
The Job Interview
Getting Paid What You Are Worth
Exercise 30 - 1
Resume Questionnaire
Sample Resume # 1
Sample Cover Letter # 1
Sample Resume # 2
Sample Resume # 3