9780073374598

TERM	PRICE	DUE
SEMESTER	$41.25	Aug 02
QUARTER	$39.19	Jul 17
SHORT TERM	$11.62	Jun 07

The seventh edition of Insurance in the Medical Office: From Patient to Payment emphasizesthe medical billing cycle—ten steps that clearly identify all the components needed to successfully manage the medical insurance claims process. Studying thiscycle shows how administrative medical assistants must first collect accurate patient information and then be familiar with the rules and guidelines of each health plan in order to submit proper documentation and follow up on payments. This ensures that offices receive maximum, appropriate reimbursement for services provided. Withoutan effective administrative staff, a medical office would have no cash flow! Insurance in the Medical Office is specifically targeted to Medical Assisting students and addresses the role they play in contributing to the financial success of the medical office.

Preface

Acknowledgments

CHAPTER 1 From Patient to Payment: Understanding Medical Insurance

1.1 Working with Medical Insurance

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Insurance in the Medical Office: From Patient to Payment

Insurance in the Medical Office: From Patient to Payment

0073374598

Summary

Table of Contents

Preface

Acknowledgments

CHAPTER 1

From Patient to Payment: Understanding Medical Insurance

1.1 Working with Medical Insurance

1.2 Paying for Medical Services

1.3 The Medical Billing Cycle

1.4 Using PM/EHRs: The Integrated Medical Documentation and Billing Cycle

1.5 Set for Success

Chapter Review

CHAPTER 2

Electronic Health Records, HIPAA, and HITECH: Sharing and Protecting Patients' Health Information

2.1 Medical Records and the Need for Accurate Documentation

2.2 Health Care Regulations

2.3 HIPAA Privacy Rule

2.4 HIPAA Security Rule and HITECH Breach Notification Rule

2.5 HIPAA Electronic Health Care Transactions and Code Sets

2.6 Avoiding Fraud and Abuse

2.7 Compliance Plans

Chapter Review

CHAPTER 3

Patient Encounters and Billing Information

3.1 New Versus Established Patients

3.2 Information for New Patients

3.3 Information for Established Patients

3.4 Verifying Patient Eligibility for Insurance Benefits

3.5 Determining Preauthorization and Referral Requirements

3.6 Determining the Primary Insurance

3.7 Working with Encounter Forms

3.8 Communications Are Key

Chapter Review

CHAPTER 4

Diagnostic Coding

4.1 ICD-10-CM

4.2 The Alphabetic Index

4.3 The Tabular List

4.4 Using External Cause Codes and Z Codes

4.5 ICD-10-CM Official Guidelines for Coding and Reporting

4.6 Assigning Diagnosis Codes

Chapter Review

CHAPTER 5

Procedural Coding

5.1 Introduction to Procedure Codes in the CPT

5.2 Coding Steps

5.3 Coding Evaluation and Management Services

5.4 Coding Surgical Procedures

5.5 Coding Laboratory Procedures and Immunizations

5.6 HCPCS Codes

Chapter Review

CHAPTER 6

Payment Methods and Checkout Procedures

6.1 Types of Health Plans

6.2 Methods for Setting Fees

6.3 Third-Party Contracts and Guidelines

6.4 Time-of-Service (TOS) Payments

6.5 Calculating TOS Payments

6.6 Checking Out Patients

Chapter Review

CHAPTER 7

Health Care Claim Preparation and Transmission

7.1 Preparing Claims Using Practice Management Programs

7.2 Health Care Claims

7.3 Completing the CMS-1500 02/12 Claim

7.4 The HIPAA Claim

7.5 Health Care Claim Transmission

7.6 Billing Secondary Payers

Chapter Review

CHAPTER 8

Private Payers/BlueCross and BlueShield

8.1 Private Insurance

8.2 Major Private Payers and the BlueCross BlueShield Association

8.3 Billing Guidelines Under Participation Contracts

8.4 Private Payer Claims