Medical Billing & Coding for Dummies

Karen Smiley is a certified, multi-specialty coding expert in physician and outpatient reimbursement with an extensive background in commercial, Medicare, and Medicaid claims processing. She is currently a professional coder at an ambulatory surgery center that specializes in orthopedic coding.

Introduction 1

Part I: Getting to Know Medical Billing and Coding 7

Chapter 1: Dipping Your Toes in Medical Billing and Coding 9

Chapter 2: Exploring the Billing and Coding Professions 19

Chapter 3: Weighing Your Employment Options 31

Part II: Boning Up on the Need-to-Knows of Your Profession 41

Chapter 4: Compliance: Understanding the Rules 43

Chapter 5: Not-So-Strange Bedfellows: Medical Terminology and Medical Necessity 57

Chapter 6: Getting to Know the Payers 79

Part III: Keys to Becoming a Professional: Getting Certified 95

Chapter 7: Your Basic Certifi cation Options, Courtesy of the AAPC and AHIMA 97

Chapter 8: The Path to Certifi cation: Finding a Study Program 111

Chapter 9: Signing Up and Preparing for the Certifi cation Exam 129

Chapter 10: Adding Street Cred: Specialty Certifi cations and Continuing Ed 147

Part IV: Dealing with the Nitty-Gritty On-the-Job Details 159

Chapter 11: Processing a Run-of-the-Mill Claim: An Overview161

Chapter 12: Honing In on How to Prepare an Error-free Claim 177

Chapter 13: From Clearinghouse to Accounts Receivable to Money in the Pocket 193

Chapter 14: Handling Disputes and Appeals 203

Chapter 15: Keeping Up with the Rest of the World223

Part V: Working with Stakeholders 235

Chapter 16: Dealing with Commercial Insurance Claims 237

Chapter 17: Caring about Medicare 249

Chapter 18: Client Relations and Coding Ethics: Being an Advocate for Your Employer 261

Part VI: The Part of Tens 277

Chapter 19: Ten Common Billing and Coding Mistakes and How to Avoid Them 279

Chapter 20: Ten Acronyms to Burn into Your Brain 283

Chapter 21: Ten Tips from Billing and Coding Pros 287

Glossary 293

Index 303