Descripciones mejoradas de Syndetics:

Medical billing is one of the fastest-growing employment opportunities in the United States today. Insurance companies, medical offices, hospitals and other health care providers are in great need of trained personnel to create medical claims. This book will ensure learning the skills necessary to become a successful medical claims biller. It is presented in a comprehensive, yet user friendly way, following a logical learning format beginning with a broad base of information and then, step by step, following the course for creation of a medical claim.

This book teaches the skills necessary to become a well-rounded medical biller. By completing this course of study with a satisfactory grade, the user will be granted a certificate and can have the opportunity to work towards an "Honors Certificate", which is even more valuable to a potential employer.

Tabla de contenidos provista por Syndetics

• Section 1 Medical Practice Administration(p. 1)
• 1 Introduction to Medical Billing and Coding(p. 3)
• Job Roles and Duties(p. 4)
• The Medical Team(p. 4)
• Types of Healthcare Settings(p. 5)
• Basic Skill Requirements of the Medical Biller(p. 6)
• Interpersonal Skills(p. 6)
• Stress(p. 8)
• Prevacation Work Planning(p. 9)
• Certification Programs for Medical Billers(p. 10)
• Legal Issues(p. 10)
• Fraud(p. 13)
• HIPAA and Fraud and Abuse(p. 14)
• Embezzlement(p. 15)
• Employee Bonding and Errors and Omission Insurance(p. 16)
• Claim Audits(p. 16)
• Medical Ethics(p. 16)
• Subpoenas(p. 17)
• Instances in Which the Patient Should Be Notified and the File Notated(p. 19)
• 2 Clinical Records and Medical Documentation(p. 28)
• Medical Charts(p. 29)
• Filing the Chart(p. 31)
• Medical Documentation Rules(p. 32)
• SOAP Notes(p. 33)
• Signature Cards(p. 34)
• Retention of Records(p. 34)
• Storing Medical Records(p. 35)
• Electronic Medical Charting(p. 36)
• Computerized Files(p. 37)
• Record Transfers(p. 38)
• Patient Information Sheet(p. 39)
• Release of Information Form(p. 42)
• Assignment of Benefits Form(p. 46)
• Patient History Form(p. 46)
• Insurance Verification(p. 46)
• Additional Suggestions(p. 49)
• Section 2 Health Insurance Programs(p. 55)
• 3 Health Insurance Contract Interpretation(p. 57)
• Blue Cross/Blue Shield(p. 58)
• Contract Provisions(p. 58)
• Contract Benefits(p. 63)
• Exclusions(p. 72)
• Allowed Amounts(p. 72)
• Precertification of Inpatient Admissions(p. 73)
• Utilization Review(p. 73)
• Second Surgical Opinion Consultations(p. 74)
• Coordination of Benefits(p. 75)
• 4 Medicare and Medicaid(p. 101)
• Medicare(p. 102)
• Medicare Eligibility(p. 102)
• The Parts of Medicare(p. 103)
• Allowable Charges(p. 104)
• Medicare Health Insurance Card (HIC)(p. 105)
• Medicare Physician Identification Numbers(p. 106)
• Medicare Billing Notices(p. 107)
• Assignment of Benefits(p. 112)
• Medicare Secondary Payer(p. 115)
• Diagnosis-Related Group Billing(p. 116)
• Durable Medical Equipment(p. 117)
• Medicare Denials(p. 117)
• Advance Beneficiary Notice (ABN)(p. 117)
• The Medicare Appeals Process(p. 120)
• Medicare Fraud and Abuse(p. 122)
• Medicare Supplemental Insurance(p. 125)
• Medicare and Managed Care(p. 125)
• Medicare Notice of Non-Coverage(p. 125)
• Medicare Billing Guidelines(p. 126)
• Medicaid(p. 126)
• Medicaid Covered Services(p. 128)
• Reimbursement from Medicaid(p. 129)
• Medicaid as Secondary Payer(p. 130)
• Treatment Authorization Request(p. 130)
• Medicaid Billing Guidelines(p. 133)
• 5 Workers' Compensation(p. 140)
• Intent of the Workers' Compensation System(p. 141)
• Employee Activities(p. 142)
• Time Limits(p. 143)
• Fraud and Abuse(p. 143)
• Types of Workers' Compensation Benefits(p. 144)
• Treating Physicians(p. 146)
• Medical-Legal Evaluations(p. 146)
• Medical Service Order(p. 146)
• Patient Records(p. 147)
• Doctor's First Report of Injury/Illness(p. 147)
• Progress Reports(p. 151)
• Physician's Final Report(p. 151)
• Billing for Workers' Compensation Services(p. 152)
• Third-Party Liability(p. 153)
• Liens(p. 153)
• Delinquent Claims(p. 157)
• Delay of Adjudication(p. 157)
• Workers' Compensation Appeals(p. 157)
• Reversals(p. 157)
• 6 Managed Care(p. 162)
• Rising Healthcare Costs(p. 163)
• Managed Care(p. 163)
• HMO Coverage(p. 165)
• Preferred Provider Organizations(p. 165)
• Self-Insurance(p. 167)
• Billing Managed Care Plans(p. 167)
• Groups/IPAs(p. 169)
• Capitation Payments(p. 172)
• Appointment Scheduling(p. 174)
• Authorizations, Referrals, and Second Opinions(p. 175)
• Denial of Services to Members(p. 177)
• Member Grievances and Complaints(p. 178)
• Transfers(p. 179)
• Disenrollment(p. 179)
• Continuing Care(p. 180)
• Miscellaneous Services(p. 181)
• Sanctions(p. 182)
• Claim Payments(p. 182)
• Section 3 Finances and Accounting(p. 193)
• 7 Medical Practice Accounting(p. 195)
• Patient Accounting(p. 196)
• Accounts Payable/Receivable(p. 196)
• Patient Ledger Card/Statement of Account(p. 196)
• Insurance Payments(p. 198)
• Patient Payments(p. 200)
• Posting Payments(p. 200)
• Balance Billing(p. 200)
• Follow-Ups(p. 201)
• Collections(p. 202)
• Collections Procedures(p. 204)
• Small Claims Court(p. 207)
• Practice Accounting(p. 208)
• Petty Cash(p. 208)
• The Day Sheet/Daily Journal(p. 209)
• Office Reports(p. 211)
• Section 4 Medical Coding(p. 219)
• 8 Reference Books(p. 221)
• ICD-9-CM(p. 222)
• CPT(p. 222)
• Medical Dictionary(p. 222)
• Merck Manual(p. 223)
• Physicians' Desk Reference(p. 223)
• HCPCS(p. 226)
• 9 International Classification of Disease (ICD-9-CM) Coding(p. 245)
• History of the ICD-9-CM(p. 246)
• Contents of the ICD-9-CM(p. 246)
• How to Use the ICD-9-CM(p. 246)
• General Guidelines(p. 247)
• Main Terms(p. 248)
• Exceptions(p. 249)
• V Codes(p. 252)
• E Codes(p. 253)
• Signs and Symbols Used in the ICD-9-CM(p. 253)
• ICD-10-CM(p. 254)
• 10 Current Procedural Terminology (CPT) Coding(p. 266)
• Using the CPT(p. 267)
• Semicolons in the CPT(p. 267)
• Signs and Symbols Used in the CPT(p. 268)
• Using the CPT Index(p. 268)
• Modifiers(p. 268)
• Unlisted Codes(p. 268)
• Evaluation and Management Codes(p. 268)
• Anesthesia(p. 271)
• Surgery(p. 275)
• Radiology/X-ray(p. 280)
• Pathology/Laboratory(p. 281)
• Medicine(p. 282)
• Section 5 Medical Billing(p. 299)
• 11 The CMS-1500 Form and Medical Billing Procedures(p. 301)
• Superbill(p. 302)
• CMS-1500 Block Explanations(p. 306)
• 1500 Health Insurance Claim Form (Version 08/05)(p. 308)
• Patient Claim Form(p. 310)
• Billing for Services(p. 311)
• Incomplete Data Master List(p. 314)
• Determining the Proper Billing Amount(p. 315)
• Special Services(p. 316)
• Claims Submission Process(p. 316)
• Clean Claims(p. 318)
• Coordination of Benefits(p. 318)
• COB with Health Maintenance Organizations(p. 319)
• Collecting the Patient Portion(p. 320)
• Tricare(p. 321)
• Billing Reports(p. 323)
• Prompt Payment Laws(p. 323)
• Tracer Claims/Delinquent Claims(p. 325)
• Denied Claims(p. 325)
• Resubmission of Claims(p. 325)
• Adjusted Claims(p. 325)
• Review and Appeals(p. 326)
• Balance Billing Patients for Downcoded or Denied Claims(p. 326)
• State Insurance Commissioner(p. 326)
• Maximum Reimbursement Guidelines(p. 327)
• 12 The UB-92 Form and Hospital Billing Procedures(p. 333)
• Field Locator # and Name/Description(p. 335)
• Uniform Bill (UB-04)(p. 339)
• Item 42, Hospital Revenue Codes(p. 339)
• Item 53, Assignment of Benefits(p. 342)
• Chargemaster Descriptions(p. 345)
• Entering Charges(p. 346)
• How Billing Affects Other Departments(p. 347)
• Preauthorization, Precertifications, and Utilization Reviews(p. 347)
• Ambulatory Surgical Centers(p. 348)
• 13 Abstracting, Billing, and Coding from Medical Reports(p. 357)
• Abstracting from Medical Records(p. 358)
• Triage Reports(p. 358)
• Operative Reports(p. 358)
• Diagnostic Testing Reports(p. 358)
• Medical History and Physical Examination Reports(p. 358)
• Section 6 General Office Procedures(p. 389)
• 14 Basic Office Functions and Communications(p. 391)
• Mail(p. 392)
• Office Machines(p. 396)
• Tickler Files(p. 397)
• Practice Communication(p. 398)
• The Opening(p. 399)
• The Body(p. 399)
• The Closing(p. 399)
• Correspondence Containing Negative Content(p. 399)
• Format of the Letter(p. 400)
• Memos(p. 400)
• Patient Relations(p. 405)
• First Impressions and Image(p. 406)
• Customer Service Job Functions(p. 406)
• The Art of Listening(p. 407)
• Maintaining an Appointment Calendar(p. 411)
• Section 7 Securing Employment(p. 421)
• 15 Job Search Preparation(p. 423)
• Key Descriptions(p. 424)
• Printer Tape Symbols(p. 425)
• Computer Basics(p. 425)
• The Computer(p. 425)
• The Monitor(p. 427)
• The Keyboard(p. 428)
• Computer Terms(p. 430)
• Job Search Preparation(p. 433)
• Job Search Objectives(p. 433)
• Uniqueness(p. 433)
• Target Audience(p. 433)
• Build Your Database(p. 434)
• The Resume(p. 434)
• The Cover Letter(p. 436)
• Marketing Yourself(p. 437)
• The Job Interview(p. 438)
• Getting Paid What You Are Worth(p. 440)
• Section 8 Appendices(p. 457)
• Appendix A Provider and Medical Abbreviations(p. 459)
• Provider Abbreviations(p. 460)
• Medical Abbreviations(p. 461)
• Appendix B Forms(p. 464)
• Patient Information Sheet(p. 465)
• Insurance Coverage Form(p. 467)
• Doctor's First Report of Occupational Injury or Illness(p. 468)
• Lien Letter(p. 469)
• Lien Form(p. 470)
• Insurance Tracer(p. 471)
• Encounter Form(p. 472)
• Patient Receipt(p. 473)
• Ledger Card/Statement of Account(p. 474)
• Day Sheet/Daily Journal(p. 475)
• Deposit Slip/Ticket(p. 476)
• Patient Claim Form(p. 477)
• Superbill/Charge Slip(p. 479)
• Insurance Claim Register(p. 480)
• CMS-1500 Claim Form(p. 481)
• UB-92 Billing Form(p. 482)
• Hospital Admission Form(p. 483)
• Domestic Return Receipt(p. 484)
• Certified Mail Form(p. 485)
• Ground Tracking ID COD Prepaid(p. 486)
• COD Airbill(p. 487)
• COD Shipper Receipt(p. 488)
• Ground Tracking ID Prepaid(p. 488)
• Airbill(p. 489)
• Stationery(p. 490)
• Envelope(p. 491)
• Appendix C Tables(p. 492)
• Patient Data Table(p. 493)
• Provider Data Table(p. 494)
• Order of Benefit Determination(p. 495)
• Medicare Secondary Payer(p. 496)
• Quick Reference Codes(p. 497)
• Place of Service Codes(p. 501)
• Hospital Revenue Codes(p. 504)
• Hospital Form Locator Codes(p. 516)
• State Abbreviations(p. 521)
• Other Address Abbreviations(p. 522)
• Appendix D CMS-1500/1500 Health Insurance Claim Form(p. 523)
• CMS-1500 Claim Form Matrix(p. 524)
• CMS-1500 Sample Claims(p. 543)
• 1500 Health Insurance Claim Form(p. 548)
• Appendix E UB-92 (CMS-1450)/UB-04(p. 550)
• UB-92 Form Matrix(p. 551)
• UB-92 Sample Claims(p. 576)
• UB-92 to UB-04 Crosswalk(p. 581)
• Glossary(p. 586)
• Credits(p. 595)
• Index(p. 597)