Main description:

For courses in Introduction to Healthcare Billing and Medical Coding

A clear illustration of the key health insurance concepts readers need to learn to be workplace ready

Comprehensive Health Insurance: Billing, Coding, and Reimbursement provides readers with the knowledge and skills needed to work in a variety of administrative positions in the medical field. It covers the foundations of insurance, billing, coding, and reimbursement, offering a comprehensive view of how each element in the process affects all other steps. Students learn not only the submission of claims to the insurance carrier, but also reviewing medical records, verifying patient benefits, submitting a secondary claim, posting payments and appealing the insurance carrier's decision. Numerous case studies and patient files are included throughout to demonstrate refunds and appeals, auditing, and compliance, Medicare calculations, and professionalism. The Third Edition includes 2017 ICD-10, CPT, and HCPCS codes; information about the ramifications of the Affordable Care Act; and current information on health care changes, trends, and the future of health care.

For even more practice and review opportunities pair Comprehensive Health Insurance with the Student Workbook. The Workbook (ISBN: 0134787293) contains key terms, chapter objectives, chapter outlines, critical-thinking questions, practice exercises, review questions, and end-of-workbook tests/case study-type problems that test student knowledge of the key concepts presented in the core textbook.

Also available with MyLab Health Professions for the Comprehensive Health Insurance course

MyLab is an online homework, tutorial, and assessment program designed to work with this text to engage students and improve results. Within its structured environment, students have ample opportunity to practice what they learn and test their understanding to better absorb course material and understand difficult concepts.

Note: You are purchasing a standalone product; MyLab does not come packaged with this content. Students, if interested in purchasing this title with MyLab, ask your instructor for the correct package ISBN and Course ID. Instructors, contact your Pearson representative for more information.

If you would like to purchase both the physical text and MyLab, search for:
0134699815 / 9780134699813 Comprehensive Health Insurance: Billing, Coding, and Reimbursement Plus MyLab Health Professions with Pearson eText -- Access Card Package

Package consists of:

013445877X / 9780134458779 Comprehensive Health Insurance: Billing, Coding, and Reimbursement

0134709705 / 9780134709703 MyLab Health Professions with Pearson eText -- Access Card -- for Comprehensive Health Insurance

Contents:

SECTION I: A CAREER IN HEALTH CARE

1. Introduction to Professional Billing and Coding Careers

SECTION II: THE RELATIONSHIP BETWEEN THE PATIENT, PROVIDER, AND CARRIER

2. Understanding Managed Care: Insurance Plans

3. Understanding Managed Care: Medical Contracts and Ethics

4. Introduction to the Health Insurance Portability and Accountability Act (HIPAA)

SECTION III: MEDICAL CODING

5. ICD-10-CM Medical Coding

6. Introduction to CPT and Place of Service Coding

7. Coding Procedures and Services

8. HCPCS and Coding Compliance

9. Auditing

SECTION IV: MEDICAL CLAIMS

10. Physician Medical Billing

11. Hospital Medical Billing

SECTION V: GOVERNMENT MEDICAL BILLING

12. Medicare Medical Billing

13. Medicaid Medical Billing

14. TRICARE Medical Billing

SECTION VI: ACCOUNTS RECEIVABLE

15. Explanation of Benefits and Payment Adjudication

16. Refunds, Follow-Up, and Appeals

SECTION VII: INJURED EMPLOYEE MEDICAL CLAIM

17. Workers' Compensation

Appendix A: Completing the CMS-1500 Form for Physician Outpatient Billing

Appendix B: Completing the CMS-1500 Form for Physician Outpatient Billing Plus Determining the Correct Diagnostic and Procedure Codes

Appendix C: Completing the UB-04 Form for Hospital Billing

Appendix D: Medical Forms

Appendix E: Acronyms and Abbreviations

Appendix F: Medical Terminology Word Parts

Appendix G: Helpful Websites

Glossary

Index