Medical insurance : a revenue cycle process approach / Joanne D. Valerius, RHIA, MPH, Oregon Health & Science University, Nenna L. Bayes, AAS, BBA, M.Ed., CPC, Ashland Community and Technical College, Retired, Cynthia Newby, CPC, CPC-P, Amy L. Blochowiak, MBA, ACS, AIAA, AIRC, ARA, FLHC, FLMI, HCSA, HIA, HIPAA, MHP, PCS, SILA-F, Northeast Wisconsin Technical College.

Por:

Valerius, Joanne [author.]

Editor: New York, NY : McGraw Hill LLC, [2024]Edición: Ninth editionDescripción: xviii, 537 pages : illustrations ; 28 cmTipo de contenido:

text

Tipo de medio:

unmediated

Tipo de soporte:

volume

ISBN:

9781265166717
1265166714
9781266269578
1266269576

Tema(s):

Clasificación CDD:

368.38/2 23/eng/20220923

Clasificación LoC:

HG9383 .V45 2024

Contenidos:

Part 1. WORKING WITH MEDICAL INSURANCE AND BILLING -- 1. Introduction to the Revenue Cycle -- 2. Electronic Health Records, HIPAA, and HITECH: Sharing and Protecting Patients’ Health Information -- 3. Patient Encounters and Billing Information -- Part 2. CLAIM CODING -- 4. Diagnostic Coding: ICD-10-CM -- 5. Procedural Coding: CPT and HCPCS -- 6. Visit Charges and Compliant Billing -- Part 3. CLAIMS -- 7. Healthcare Claim Preparation and Transmission -- 8. Private Payers/ACA Plans -- 9. Medicare -- 10. Medicaid -- 11. TRICARE and CHAMPVA -- 12. Workers’ Compensation and Disability/Automotive Insurance -- Part 4. CLAIM FOLLOW-UP AND PAYMENT PROCESSING -- 13. Payments (RAs), Appeals, and Secondary Claims -- 14. Patient Billing and Collections -- 15. Primary Case Studies -- 16. RA/Secondary Case Studies -- Part 5. HOSPITAL SERVICES -- 17. Hospital Billing and Reimbursement.

Resumen: "Follow the Money! Medical insurance plays an important role in the financial well-being of every healthcare business. The regulatory environment of medical insurance is now evolving faster than ever. Changes due to healthcare reform require medical office professionals to acquire and maintain an in-depth understanding of compliance, electronic health records, medical coding, and more. The eighth edition of Medical Insurance: A Revenue Cycle Process Approach emphasizes the revenue cycle steps that clearly identify all the components needed to successfully manage the medical insurance claims process. The cycle shows how administrative medical professionals "follow the money"-- Provided by publisher.

Existencias
Imagen de cubierta	Tipo de ítem	Biblioteca actual	Biblioteca de origen	Colección	Ubicación en estantería	Signatura topográfica	Materiales especificados	Info Vol	URL	Copia número	Estado	Notas	Fecha de vencimiento	Código de barras	Reserva de ítems	Prioridad de la cola de reserva de ejemplar	Reservas para cursos
	Libro	Biblioteca de Mayagüez Colección General mb				HG9383 .V45 2024 (Navegar estantería(Abre debajo))				c. 1	Disponible			50000003296026

Total de reservas: 0

Descripciones mejoradas de Syndetics:

Medical Insurance: A Revenue Cycle Process Approach emphasizes the revenue cycle--ten steps that clearly identify all the components needed to successfully manage the medical insurance claims process. The cycle shows how administrative medical professionals "follow the money."

Includes bibliographical references and indexes.

"Follow the Money! Medical insurance plays an important role in the financial well-being of every healthcare business. The regulatory environment of medical insurance is now evolving faster than ever. Changes due to healthcare reform require medical office professionals to acquire and maintain an in-depth understanding of compliance, electronic health records, medical coding, and more. The eighth edition of Medical Insurance: A Revenue Cycle Process Approach emphasizes the revenue cycle steps that clearly identify all the components needed to successfully manage the medical insurance claims process. The cycle shows how administrative medical professionals "follow the money"-- Provided by publisher.

Tabla de contenidos provista por Syndetics

Preface(ix)
Part 1 Working with Medical Insurance and Billing(1)
Chapter 1 Introduction to the Revenue Cycle(2)
1.1 Working in the Medical Insurance Field(3)
1.2 Medical Insurance Basics(6)
1.3 Healthcare Plans(8)
1.4 Health Maintenance Organizations(11)
1.5 Preferred Provider Organizations(15)
1.6 Consumer-Driven Health Plans(15)
1.7 Medical Insurance Payers(16)
1.8 The Revenue Cycle(18)
1.9 Achieving Success(23)
1.10 Moving Ahead(26)
Chapter Review(27)
Chapter 2 Electronic Health Records, HIPAA, and HITECH: Sharing and Protecting Patients' Health Information(33)
2.1 Medical Record Documentation: Electronic Health Records(34)
2.2 Healthcare Regulation: HIPAA, HITECH, and ACA(41)
2.3 Covered Entities and Business Associates(42)
2.4 HIPAA Privacy Rule(44)
2.5 HIPAA Security Rule(52)
2.6 HITECH Breach Notification Rule(53)
2.7 HIPAA Electronic Health Care Transactions and Code Sets(55)
2.8 Omnibus Rule and Enforcement(57)
2.9 Fraud and Abuse Regulations(58)
2.10 Compliance Plans(60)
Chapter Review(62)
Chapter 3 Patient Encounters and Billing Information(69)
3.1 New Versus Established Patients(70)
3.2 Information for New Patients(70)
3.3 Information for Established Patients(79)
3.4 Verifying Patient Eligibility for Insurance Benefits(81)
3.5 Determining Preauthorization and Referral Requirements(84)
3.6 Determining the Primary Insurance(87)
3.7 Working with Encounter Forms(89)
3.8 Understanding Time-of-Service (TOS) Payments(91)
3.9 Calculating TOS Payments(93)
Chapter Review(97)
Part 2 Claim Coding(103)
Chapter 4 Diagnostic Coding: ICD-10-CM(104)
4.1 ICD-10-CM(105)
4.2 Organization of ICD-10-CM(106)
4.3 The Alphabetic Index(107)
4.4 The Tabular List(110)
4.5 ICD-10-CM Official Guidelines for Coding and Reporting(114)
4.6 Overview of ICD-10-CM Chapters(121)
4.7 Coding Steps(125)
4.8 ICD-10-CM and ICD-9-CM(127)
Chapter Review(129)
Chapter 5 Procedural Coding: CPT and HCPCS(135)
5.1 Current Procedural Terminology (CPT), Fourth Edition(136)
5.2 Organization(138)
5.3 Format and Symbols(142)
5.4 CPT Modifiers(145)
5.5 Coding Steps(148)
5.6 Evaluation and Management Codes(150)
5.7 Anesthesia Codes(158)
5.8 Surgery Codes(160)
5.9 Radiology Codes(164)
5.10 Pathology and Laboratory Codes(166)
5.11 Medicine Codes(167)
5.12 Categories II and III Codes(169)
5.13 HCPCS(170)
Chapter Review(176)
Chapter 6 Visit Charges and Compliant Billing(184)
6.1 Compliant Billing(185)
6.2 Knowledge of Billing Rules(185)
6.3 Compliance Errors(188)
6.4 Strategies for Compliance(190)
6.5 Audits(193)
6.6 Physician Fees(196)
6.7 Payer Fee Schedules(197)
6.8 Calculating RBRVS Payments(199)
6.9 Fee-Based Payment Methods(200)
6.10 Capitation(203)
6.11 Collecting Time-of-Service (TOS) Payments and Checking Out Patients(204)
Chapter Review(206)
Part 3 Claims(213)
Chapter 7 Healthcare Claim Preparation and Transmission(214)
7.1 Introduction to Healthcare Claims(215)
7.2 Completing the CMS-1500 Claim: Patient Information Section(216)
7.3 Types of Providers(223)
7.4 Completing the CMS-1500 Claim: Physician/ Supplier Information Section(223)
7.5 The HIPAA 837P Claim(236)
7.6 Completing the HIPAA 837P Claim(239)
7.7 Checking Claims Before Transmission(245)
7.8 Clearinghouses and Claim Transmission(246)
Chapter Review(248)
Chapter 8 Private Payers/ACA Plans(255)
8.1 Group Health Plans(256)
8.2 Types of Private Payers(259)
8.3 Consumer-Driven Health Plans(263)
8.4 Major Private Payers and the BlueCross BlueShield Association(266)
8.5 Affordable Care Act (ACA) Plans(269)
8.6 Participation Contracts(271)
8.7 Interpreting Compensation and Billing Guidelines(275)
8.8 Private Payer Billing Management: Plan Summary Grids(281)
8.9 Preparing Correct Claims(283)
8.10 Capitation Management(289)
Chapter Review(290)
Chapter 9 Medicare(298)
9.1 Eligibility for Medicare(299)
9.2 The Medicare Program(299)
9.3 Medicare Coverage and Benefits(301)
9.4 Medicare Participating Providers(306)
9.5 Nonparticipating Providers(312)
9.6 Original Medicare Plan(314)
9.7 Medicare Advantage Plans(316)
9.8 Additional Coverage Options(317)
9.9 Medicare Billing and Compliance(318)
9.10 Preparing Primary Medicare Claims(322)
Chapter Review(326)
Chapter 10 Medicaid(333)
10.1 The Medicaid Program(334)
10.2 Eligibility(334)
10.3 State Programs(337)
10.4 Medicaid Enrollment Verification(340)
10.5 Covered and Excluded Services(343)
10.6 Plans and Payments(344)
10.7 Third-Party Liability(346)
10.8 Claim Filing and Completion Guidelines(346)
Chapter Review(349)
Chapter 11 TRICARE and CHAMPVA(354)
11.1 The TRICARE Program(355)
11.2 Provider Participation and Nonparticipation(355)
11.3 TRICARE Prime(357)
11.4 TRICARE Select(358)
11.5 CHAMPVA(359)
11.6 Filing Claims(361)
Chapter Review(364)
Chapter 12 Workers' Compensation and Disability/Automotive Insurance(371)
12.1 Federal Workers' Compensation Plans(372)
12.2 State Workers' Compensation Plans(373)
12.3 Workers' Compensation Terminology(375)
12.4 Claim Process(377)
12.5 Disability Compensation and Automotive Insurance Programs(383)
Chapter Review(387)
Part 4 Claim Follow-Up and Payment Processing(395)
Chapter 13 Payments (RAs), Appeals, and Secondary Claims(396)
13.1 Claim Adjudication(397)
13.2 Monitoring Claim Status(400)
13.3 The RA(404)
13.4 Reviewing RAs(410)
13.5 Procedures for Posting(411)
13.6 Appeals(413)
13.7 Postpayment Audits, Refunds, and Grievances(416)
13.8 Billing Secondary Payers(417)
13.9 The Medicare Secondary Payer (MSP) Program, Claims, and Payments(418)
Chapter Review(422)
Chapter 14 Patient Billing and Collections(427)
14.1 Patient Financial Responsibility(428)
14.2 Working with Patients' Statements(431)
14.3 The Billing Cycle(432)
14.4 Organizing for Effective Collections(433)
14.5 Collection Regulations and Procedures(435)
14.6 Credit Arrangements and Payment Plans(440)
14.7 Collection Agencies and Credit Reporting(442)
14.8 Writing Off Uncollectible Accounts(445)
14.9 Record Retention(447)
Chapter Review(447)
Chapter 15 Primary Case Studies(451)
15.1 Method of Claim Completion(452)
15.2 About the Practice(452)
15.3 Claim Case Studies(458)
Chapter 16 RA/Secondary Case Studies(488)
16.1 Completing Secondary Claims(489)
16.2 Handling Denied Claims(489)
16.3 Processing Medicare RAs and Preparing Secondary Claims(491)
16.4 Processing Commercial Payer RAs and Preparing Secondary Claims(493)
16.5 Calculating Patients' Balances(495)
Part 5 Hospital Services(501)
Chapter 17 Hospital Billing and Reimbursement(502)
17.1 Healthcare Facilities: Inpatient Versus Outpatient(503)
17.2 Hospital Billing Cycle(504)
17.3 Hospital Diagnosis Coding(513)
17.4 Hospital Procedure Coding(515)
17.5 Payers and Payment Methods(517)
17.6 Claims and Follow-Up(522)
Chapter Review(533)
Appendix A Place of Service Codes(A-1)
Appendix B Forms(B-1)
Abbreviations(AB-1)
Glossary(GL-1)
Index(IN-1)

Imprimir
Citar
Agregar a su carrito (remover)
Guardar registro
BIBTEX Dublin Core ISBD MARC (no-Unicode/MARC-8) MARC (Unicode/UTF-8) MARC (Unicode/UTF-8, Estándar) MARCXML MODS (XML) RIS
Más búsquedas

Buscar este título en:
HORIZON