Gain the skills you need to succeed in insurance coding and billing! Fordney’s Medical Insurance and Billing, 17th Edition helps you master the insurance billing specialist’s role and responsibilities in areas such as diagnostic coding, procedural coding, HCPCs coding, medical documentation, billing, and collection. Using clear explanations, this book covers all types of insurance coverage commonly encountered in hospitals, physicians’ offices, and clinics. Step-by-step guidelines lead you through the submission of electronic claims and paper claims, as well as the job search and professional advancement. Written by coding specialist and educator Linda M. Smith, this market-leading text is a complete guide to becoming an efficient insurance billing specialist.
Unit 1 Career Role and Responsibilities 1. 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