Unit One: Career Role and Responsibilities
1. Role of an Insurance Billing Specialist
2. Privacy, Security and HIPAA
3. Compliance, Fraud and Abuse
Unit Two: Introduction to the Revenue Cycle Process
4. Basics of Health Insurance
5. The Blue Plans, Private Insurance, and Managed Care Plans
7. Medicaid and other State Programs
8. Tricare and Veterans’ Health Care
9. Workers’ Compensation
10. Disability Income Insurance and Disability Benefit Programs
Unit Three: Documentation and Coding
11. Medical Documentation and the Electronic Health Record
12. Diagnostic Coding
13. Procedural Coding
Unit Four: Claims Submission in The Medical Office
14. The Paper Claim CMS-1500
15. The Electronic Claim
Unit Five: The Claim Follow Up and Payment Process
16. Receiving Payments and Insurance Problem Solving
17. Office and Insurance Collection Strategies
Unit Six: Healthcare Facility Billing
18. Ambulatory Surgical Center
19. Hospital Outpatient and Inpatient Billing
Unit Seven: Employment
20. Seeking a Job and Attaining Professional Advancement
Get a solid foundation in insurance billing and coding! Trusted for more than 30 years, Fordney’s Medical Insurance equips you with the medical insurance skills you need to succeed in any of today’s outpatient settings. The 15th edition has been expanded to include inpatient insurance and billing and ambulatory surgical center billing. Updated coverage emphasizes the role of the medical insurance specialist in areas such as diagnostic coding, procedural coding, Medicare, HIPAA, and bill collection strategies. As with previous editions, all the plans that are most commonly encountered in clinics and physicians’ offices are incorporated into the text, as well as icons for different types of payers, lists of key abbreviations, and numerous practice exercises that accurately guide you through the process of filling out claim forms. In addition, SimChart® for the Medical Office (SCMO) activities on the companion Evolve website give you the opportunity to practice using electronic medical records.
• Separate chapter on HIPAA Compliance in Insurance Billing, as well as Compliance Alerts throughout highlights important HIPAA compliance issues to ensure you are compliant with the latest regulations.
• Separate chapter on documentation in the medical office covers the principles and rationales of medical documentation.
• Increased focus on electronic filing/claims submission prepares you for the industry-wide transition to electronic claims submission.
• Emphasis on the business of running a medical office and the importance of the medical insurance specialist prepares you for your role in the workplace.
• Detailed examples of potential situations throughout text signal you to be attentive to these types of occurrences.
• Specialized icons throughout text alert you to the connections and special considerations related to specific topics that medical insurance specialists need to be aware of.
• Procedures clearly outline in step-by-step format detail common responsibilities of the medical insurance specialist.
• UNIQUE! Interactive UB-04 Form filler on Evolve gives you additional practice with inpatient Electronic Health Records.
• SimChart® for the Medical Office (SCMO) application activities on the companion Evolve website add additional functionality to the insurance module on the SCMO roadmap.
• Key terms are defined and emphasized throughout the text to reinforce your understanding of new concepts and terminology.
New To This Edition:
• NEW! Expanded coverage of inpatient insurance billing, including diagnosis and procedural coding provides you with the foundation and skills needed to work in the physician office, outpatient, and inpatient setting.
• NEW! Expanded coverage of Ambulatory Surgical Center (ASC) billing chapter provides you with the foundation and skills needed to work in this outpatient setting.
• NEW! Updated information on general compliance issues, HIPAA, Affordable Care Act and coding ensures that you have the knowledge needed to enter today's ever-changing and highly regulated healthcare environment.