Rent 9780078252532 | From Patient to Payment : Insurance Procedures for the Medical Office, Student Text with Data D...

Summary Table of Contents

This concise, practical text-workbook provides extensive real-world practice with the universal medical insurance claim form, the HCFA 1500. Includes flow charts, claims processing forms, and medical reports. Coding and billing content is based on industry practice and addresses electronic claims and a variety of compliance issues. The text provides a brief introduction to MediSoft Advanced Patient Billing Software.

Preface

viii

Acknowledgments

From Patient to Payment

(14)

Introduction to Medical Insurance

... MORE

(1)

Common Types of Medical Insurance

(1)

The Insurance Claim Process

(5)

Professional Focus: The Internet and Medical Insurance

(1)

The Responsibilities of a Medical Insurance Specialist

(1)

Effects of Insurance Claim Errors

(4)

Legal Considerations

(10)

Confidentiality of Medical Records

(1)

Medicolegal Information

(4)

Medicolegal Records: Retention and Documentation

(1)

Avoiding Fraud

(3)

Professional Focus: Compliance Plans

(2)

Diagnostic Coding

(20)

Introduction to Diagnostic Coding

(1)

Coding Basics for Physician Practices

(3)

Professional Focus: The Encounter Form

(1)

Using the ICD

(4)

Five Steps to Diagnostic Coding

(6)

Preview of ICD-10-CM

(4)

Procedural Coding

(16)

Introduction to Procedure Codes in the CPT

(2)

Coding Evaluation and Management Services

(2)

Professional Focus: Certification as a Medical Coder

(1)

Coding Surgical Procedures

(1)

Coding Laboratory Procedures

(1)

Coding Immunizations

(1)

HCPCS Codes

(1)

Five Steps for Locating Correct CPT Codes

(5)

Preview of CPT 5

(3)

The HCFA-1500 Form

(34)

Introduction to the HCFA-1500 Claim Form

(4)

Professional Focus: Administrative Simplification

(1)

Patient and Insured Information

(9)

Physician or Supplier Information

(10)

Claim Completion

(9)

Electronic Claims

(12)

Using Computers to Process Claims

(1)

Electronic Claims and Paper Claims: Advantages and Disadvantages

(2)

Professional Focus: Career Opportunities in Medical Office Settings

100

(1)

Transmission Methods for Electronic Claims

100

(2)

Optical Character Recognition

102

(1)

Security Concerns Associated with Electronic Transmission

103

(1)

Electronic Transaction Standards

104

(1)

Steps in the Submission Process

104

(4)

Reimbursement: Managed Care and Indemnity Plans

108

(14)

The Reimbursement Process

110

(2)

Types of Managed Care Plans

112

(2)

Professional Focus: Career Opportunities with Insurance Companies

114

(1)

Methods of Setting Allowed Charges

114

(1)

The Electronic Remittance Advice/Explanation of Benefits

115

(3)

Processing Reimbursement Information

118

(4)

Blue Cross and Blue Shield

122

(8)

Introduction to Blue Cross and Blue Shield

124

(1)

Federal Employee Health Benefits Plan

124

(1)

Key Features of Blue Cross and Blue Shield Plans

125

(1)

Physician Participation and Reimbursement

125

(1)

Filing Claims for Special Cases and National Groups

126

(1)

Membership Card Information

126

(1)

Filing Deadlines

127

(3)

Professional Focus: Blue Cross/Blue Shield

128

(2)

Medicaid

130

(8)

Introduction to Medicaid

132

(1)

Medicaid Coverage

132

(2)

Professional Focus: Managed Care and Medicaid

133

(1)

Medicaid Eligibility

134

(1)

Filing Medicaid Claims

134

(4)

Medicare

138

(12)

Medicare Overview

140

(3)

Filing Medicare Claims

143

(2)

Professional Focus: Medicare's Correct Coding Initiative

144

(1)

Who Pays First?

145

(5)

Tricare and Champva

150

(10)

Tricare

152

(1)

Champva

153

(1)

Professional Focus: Privacy Rules

154

(1)

Beneficiary Identification

154

(1)

Billing Beneficiaries

155

(1)

Primary or Secondary Payer?

156

(4)

Workers' Compensation

160

(8)

When Employees Are Hurt at Work

162

(1)

Federal Programs, Forms, and Procedures

162

(1)

Professional Focus: Workers' Compensation Terminology

163

(1)

State Programs, Forms, and Procedures

163

(2)

Keeping Separate Records

165

(3)

Disability

168

(8)

Replacing Lost Income

170

(1)

Filing for Disability Benefits

171

(5)

Professional Focus: Consulting and Educational Career Opportunities

173

(3)

Dental Insurance

176

(14)

Introduction to Dental Terms

178

(3)

Dental Insurance

181

(1)

Professional Focus: Dental Injury Claims and Workers' Compensation

182

(1)

Processing Dental Claims

182

(8)

Hospital Insurance

190

(12)

Health Care Facilities: Inpatient Versus Outpatient

192

(1)

Hospital Claims Processing

193

(2)

Inpatient (Hospital) Coding

195

(1)

Payers and Payment Methods

196

(1)

Claims and Follow up

197

(5)

Professional Focus: Career Opportunities in Hospitals

199

(3)

Reimbursement Follow-Up and Collections

202

(12)

Delinquent Payments From Carriers

204

(1)

Denied or Delayed Payments From Carriers

205

(1)

Claim Rejection Appeals and Audits

206

(2)

Patient Billing and Collections

208

(6)

Professional Focus: Career Opportunities in Collections

209

(5)

Computers and the Billing Cycle

214

(18)

Introduction to Computerized Medical Office Systems

216

(1)

Patient Billing Programs

216

(1)

The Computerized Billing Cycle

217

(5)

Professional Focus: National Electronic Transaction Standards

221

(1)

Data Entry in MediSoft

222

(10)

HCFA Form Simulations

232

(20)

Manual Simulations

234

(5)

Computerized Simulations

239

(13)

Glossary

252

(13)

Index

265

(12)

Blank HCFA Forms

277

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