Learn to comprehend the complexities of health insurance! Using a reader-friendly approach, Health Insurance Today, A Practical Approach, 6th Edition gives you a solid understanding of health insurance, its types and sources, and the ethical and legal issues surrounding it. This new edition incorporates the latest information surrounding ICD-10, the Patient Protection and Affordable Care Act, and other timely federal influencers, as it guides you through the important arenas of health insurance such as claims submission methods, the claims process, coding, reimbursement, hospital billing, and more. Plus, with hands-on UB-04 and CMS-1500 (02-12) case studies on Evolve, you will come away with a clear understanding and working knowledge of the latest advances and issues in health insurance.
Unit 1: Building a Foundation 1. The Origins of Health Insurance 2. Tools of the Trade: A Career as a Health (Medical) Insurance Professional 3. The Legal and Ethical Side of Medical Insurance 4. Healthcare Reform: Coverage Types and Sources
Unit 2: Health Insurance Basics 5. Claim Submission Methods 6. New and Traditional Reimbursement Methods 7. The Changing Face of Managed Care 8. Understanding Medicaid 9. Conquering Medicare's Challenges 10. Military Carriers 11. Miscellaneous Carriers: Workers' Compensation and Disability Insurance
Unit 3: Cracking the Codes 12. Diagnostic Coding 13. Procedural, Evaluation and Management, and HCPCS Coding Unit 4: The Claims Process 14. The Patient 15. Keys to Successful Claims Management Unit 5: Advanced Application 16. The Role of Computers in Health Insurance 17. Reimbursement Procedures: Getting Paid 18. Hospital Billing and the UB-04
Appendix A: Sample Blank CMS-1500 (02-12) Appendix B: CMS-1500 Claim Forms and Completion Instructions Appendix C: UB-04 Claim Form and Completion Instructions Glossary