- NEW HCPCS Coding chapter includes exercises for ambulance billing, supply billing, and more
- NEW exercises on professionalism cover customer service, conflict management, diversity awareness, leadership, and other competencies to help you become an effective, engaged, and highly functioning employee
- NEW exercises related to billing of automobile and liability insurance
- Self-study exercises reinforce your understanding with matching, true/false, multiple-choice, mix and match, and fill-in-the-blank questions, as well as critical thinking assignments
- Diagnostic, procedural, and HCPCS code exercises provide practice with submitting a claim or making an itemized billing statement
- Study outlines focus your review by listing the key points for each chapter
- Performance objectives make learning easier by highlighting what you need to accomplish in each chapter
- Key terms and abbreviations at the beginning of each chapter provide a quick reference to the health insurance terminology you need to know
- Critical Thinking assignments are based on short, real-world vignettes, preparing you to work in a real medical office and allowing you to apply theory learned from the textbook
Table of Contents
Unit 1 Career Role and Responsibilities1. Role of an Insurance Billing Specialist
2. Privacy, Security, and HIPAA
3. Compliance, Fraud, and Abuse
Unit 2 Introduction to Health Insurance
4. Basics of Health Insurance
5. The Blue Plans, Private Insurance, and Managed Care Plans
6. Medicare
7. Medicaid and Other State Programs
8. TRICARE and Veterans Health Care
9. Workers’ Compensation, Automobile, and Liability Insurance
10. Disability Income Insurance and Disability Benefit Programs
Unit 3 Documentation and Coding for Professional Services
11. Medical Documentation and the Electronic Health Record
12. ICD-10-CM Coding
13. CPT Coding
14. HCPCS Level II Coding
Unit 4 Claims Submission in the Medical Office
15. The Paper Claim CMS 1500
16. The Electronic Claim
Unit 5 Revenue Cycle Management
17. Receiving Payments and Insurance Problem-Solving
18. Collection Strategies
Unit 6 Health Care Facility Billing
19. Introduction to Health Care Facilities and Ambulatory Surgery Centers
20. Billing for Health Care Facilities
Unit 7 Employment
21. Seeking a Job and Attaining Professional Advancement
Authors
Linda M. Smith Training and Consulting, MedOffice Resources, Greene, NY, USA. Linda M Smith is the author of Fordney's Medical Insurance, 16e and its accompanying workbook and online course. She has revised 3 editions of HIPAA Online. She has had over 40 years of experience in the healthcare industry as a business manager and is a Certified Professional Coder (CPC). She has also earned the credentials of E/M Specialist (CEMC) and is an approved Professional Medical Coding Curriculum Instructor (CPC-I) through the American Academy of Professional Coders (AAPC). Linda provides training privately to local organizations and is an instructor with various business and technical schools. She and her associates provide training in the areas of medical ethics, medical terminology, anatomy and physiology, and medical coding and billing. They provide continuing education workshops for the organizations mentioned above. Cheryl FassettCheryl Fassett has worked in healthcare administration, billing, and coding for 34 years. She was a coding/billing specialist and account manager with Practicare Medical Management for five years and has been the practice manager for Riverside Associates in Anesthesia for the last 29 years. Her job tasks are varied and include auditing the coding, billing, and reimbursement for the practice, as well as payroll, scheduling, human resources, and working with the accounting department, legal team, and pension manager. In addition to this she has earned certifications from the AAPC in coding, billing, auditing, practice management, risk adjustment coding, clinical documentation, and instructing the AAPC coding curriculum. She was a contributor and subject matter expert for the Fordney Smith Medical Insurance and Billing 15th , 16th, and 17th editions. She has created and presented workshops and training to AAPC members, billing companies, and hospital staff on topics ranging from HIPAA compliance, revenue cycle and anesthesia coding to leadership, communication, cognitive biases and limiting beliefs.
