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Solution Manual for A Guide to Health Insurance Billing 4th Edition by Marie A Moisio

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Solution Manual for A Guide to Health Insurance Billing 4th Edition by Marie A Moisio
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Solution Manual for A Guide to Health Insurance Billing 4th Edition by Marie A Moisio

Solution Manual for A Guide to Health Insurance Billing 4th Edition by Marie A Moisio

Prepare for career success with this trusted introduction to the world of health insurance billing and the dynamic, growing field of health information management. A GUIDE TO HEALTH INSURANCE BILLING, Fourth Edition, provides a thorough, practical overview of key principles and current practices, from patient registration to claims submission. Now updated to reflect the latest trends, technology, terminology, legal and regulatory guidelines, and coding systems—including ICD-10—the new edition also features a dynamic full-color layout. The text also includes abundant exercises, examples, case studies, and activities focused on real-world applications, including step-by-step procedures for generating, processing, and submitting health insurance claims to commercial, private, and government insurance programs. An access code for SimClaim interactive online billing software is also provided; this program puts billing skills to the test with case studies that require form completion.

Additional ISBNs

1285712285, 9781285712284, 1305341589, 9781285694900, 9781305341586

Table of Contents

Preface

About the Author

Acknowledgments

How to Use This Text

How to Use the SimClaim Student Practice Software

How to Access the EncoderPro.com – Expert 59-Day Trial

Ch 1: The Insurance Billing Specialist

Learning Objectives

Key Terms

Overview

Insurance Billing Specialist

Employment Opportunities

Educational, Certification, and Career Opportunities

Abbreviations

Summary

Review Exercises

Comprehension Exercises

Critical Thinking Exercises

Websites

Ch 2: Legal Aspects of Insurance Billing

Learning Objectives

Key Terms

Overview

Origin of Legal Issues

General Legal Terms

Confidential Information

Insurance Fraud and Abuse Laws

Patient Protection and Affordable Care Act

Abbreviations

Summary

Review Exercises

Comprehension Exercises

Internet Exercise

Critical Thinking Exercises

Websites

Ch 3: Introduction to Health Insurance

Learning Objectives

Key Terms

Overview

Defining Health Insurance

Managed Care

Managed Care Organizations

Health Insurance Terminology

Paying the Bill with Health Insurance

Abbreviations

Summary

Review Exercises

Critical Thinking Exercises

Website

Ch 4: International Classification of Diseases, Tenth Revision

Learning Objectives

Key Terms

Overview

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

ICD-10-CM Components

ICD-10-CM Official Guidelines for Coding and Reporting

Assigning ICD-10-CM Diagnoses Codes

International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS)

Assigning ICD-10-PCS Procedure Codes

Abbreviations

Summary

Review Exercises

ICD-10-CM Coding Practice Sets

Coding Challenge

Websites

Ch 5: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

Learning Objectives

Key Terms

Overview

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

ICD-9-CM Components

ICD-9-CM Official Guidelines for Coding and Reporting

Assigning ICD-9-CM Diagnostic Codes

Supplementary Classifications

Miscellaneous Coding Guidelines

Assigning ICD-9-CM Procedure Codes

Miscellaneous Coding Guidelines for Procedures and Biopsies

Abbreviations

Summary

Review Exercises

ICD-9-CM Coding Practice Sets

Coding Challenge

Websites

Ch 6: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)

Learning Objectives

Key Terms

Overview

Current Procedural Terminology

Healthcare Common Procedure Coding System (HCPCS)

Abbreviations

Summary

Review Exercises

Coding Challenge

Challenge Exercise

Websites

Ch 7: Developing and Processing an Insurance Claim

Learning Objectives

Key Terms

Overview

Developing an Insurance Claim

Clinical Assessment and Treatment

Patient Departure Procedures: New and Established Patients

Assigning Numeric Codes

Insurance Claims Processing

Credit and Collections

Abbreviations

Summary

Review Exercises

Challenge Exercises

Website

Ch 8: CMS-1500 Completion Guidelines: Private and Commercial Insurance Claims

Learning Objectives

Key Terms

Overview

Optical Scanning Guidelines

CMS-1500 Guidelines

CMS-1500 Patient Information

CMS-1500 Treatment and Provider Information

Common Errors Made When Completing the CMS-1500

Abbreviations

Summary

Review Exercises

Challenge Exercise

Website

Ch 9: Electronic Claims Submission

Learning Objectives

Key Terms

Overview

Electronic Claims Submission Options

Interactive Communication

Processing Electronic Health Insurance Claims

Confidentiality and Electronic Claims Processing

Electronic Record Management

Abbreviations

Summary

Review Exercises

Challenge Activity

Website

Ch 10: Common UB-04 (CMS-1450) Completion Guidelines

Learning Objectives

Key Terms

Overview

Hospital Reimbursement

Developing the Insurance Claim

Submitting the Insurance Claim

Abbreviations

Summary

Review Exercises

Application Exercise

Challenge Exercises

Websites

Ch 11: Blue Cross/Blue Shield

Learning Objectives

Key Terms

Overview

Blue Cross/Blue Shield General Information

Blue Cross/Blue Shield Health Insurance Plans

Participating and Nonparticipating Providers

Provider Reimbursement

Blue Cross/Blue Shield Claims Submission

Abbreviations

Summary

Review Exercises

Challenge Activity

Website

Ch 12: Medicare

Learning Objectives

Key Terms

Overview

Medicare Part A

Medicare Part B

Medicare Part C

Medicare Part D: Prescription Drug Benefit

Other Medicare Health Plan Choices

Medicare Fee Schedule (MFS)

National Correct Coding Initiative (NCCI)

Medicare Claims Submission

Processing Medicare Payments

Abbreviations

Summary

Review Exercises

Challenge Activities

Websites

Ch 13: Medicaid

Learning Objectives

Key Terms

Overview

Medicaid Coverage

Medicaid Billing

Abbreviations

Summary

Review Exercises

Challenge Activities

Websites

Ch 14: TRICARE and CHAMPVA

Learning Objectives

Key Terms

Overview

Tricare Health Benefits Programs

Deers Enrollment and Tricare Reimbursement

Tricare Billing

Fraud and Abuse

CHAMPVA

CHAMPVA Billing

CMS-1500 Guidelines for CHAMPVA

Abbreviations

Summary

Review Exercises

Challenge Activities

Websites

Ch 15: Workers’ Compensation

Learning Objectives

Key Terms

Overview

Federal Workers’ Compensation Programs

Occupational Safety and Health

State-Sponsored Workers’ Compensation Programs

Workers’ Compensation Basics

Abbreviations

Summary

Review Exercises

Challenge Activities

Websites

Appendix A: Superiorland Clinic Practice Manual

How to Access Appendix A: Superiorland Clinic Practice Manual and SimClaim

General Instructions and Hints for SimClaim

Appendix B: References

Books

Periodicals

Newsletters

Websites

Appendix C: Abbreviations

Glossary

Index

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Solution Manual for A Guide to Health Insurance Billing 4th Edition by Marie A Moisio