• Unit 1: Building a Foundation
1. The Origins of Health Insurance
2. Tools of the Trade: A Career as a Health (Medical) Insurance Professional
3. The Legal and Ethical Side of Medical Insurance
4. Types and Sources of Health Insurance
• Unit 2: Health Insurance Basics
5. Claim Submission Methods
6. Traditional Fee-for-Service/Private Plans
7. Unraveling the Mysteries of Managed Care
8. Understanding Medicaid
9. Conquering Medicare’s Challenges
10. Military Carriers
11. Miscellaneous Carriers: Workers’ Compensation and Disability Insurance
• Unit 3: Cracking the Codes
12. Diagnostic Coding
13. Procedural, Evaluation and Management, and HCPCS Coding
• Unit 4: The Claims Process
14. The Patient
15. Keys to Successful Claims Management
• Unit 5: Advanced Application
16. The Role of Computers in Health Insurance
17. Reimbursement Procedures: Getting Paid
18. Hospital Billing and the UB-04
Appendix A: Sample Blank CMS-1500 (02-12)
Appendix B: CMS-1500 Claim Forms and Completion Instructions
Appendix C: UB-04 Claim Form and Completion Instructions
Master the complexities of health insurance with this easy-to-understand guide! Health Insurance Today: A Practical Approach, 7th Edition provides a solid foundation in basics such as the types and sources of health insurance, the submission of claims, and the ethical and legal issues surrounding insurance. It follows the claims process from billing and coding to reimbursement procedures, with realistic practice on the Evolve website. This edition adds coverage of the latest advances and issues in health insurance, including EHRs, Medicare, and other types of carriers. Written by Medical Assisting educators Janet Beik and Julie Pepper, this resource prepares you for a successful career as a health insurance professional.
• What Did You Learn? review questions, Imagine This! scenarios, and Stop and Think exercises ensure that you understand the material, can apply it to real-life situations, and develop critical thinking skills.
• Clear, attainable learning objectives highlight the most important information in each chapter.
• CMS-1500 software with case studies on the Evolve companion website provides hands-on practice with filling in a CMS-1500 form electronically.
• UNIQUE! UB-04 software with case studies on Evolve provides hands-on practice with filling in UB-04 forms electronically.
• UNIQUE! SimChart® for the Medical Office (SCMO) cases on Evolve give you real-world practice in an EHR environment.
• HIPAA Tips emphasize the importance of privacy and of following government rules and regulations.
• Direct, conversational writing style makes it easier to learn and remember the material.
• End-of-chapter summaries relate to the chapter-opening learning objectives, provide a thorough review of key content, and allow you to quickly find information for further review.
• Chapter review questions on Evolve help you assess your comprehension of key concepts
New To This Edition:
• NEW and UNIQUE! Patient’s Point of View boxes enable you to imagine yourself on the other side of the desk.
• NEW and UNIQUE! Opening and closing chapter scenarios present on-the-job challenges that must be resolved using critical thinking skills.
• NEW! End-of-chapter review questions ensure that you can understand and apply the material.
• NEW! Clear explanations show how electronic technology is used in patient verification, electronic claims, and claims follow-up.
• NEW! Coverage of the Affordable Care Act introduces new and innovative ways that modifications to the ACA allow people to acquire healthcare coverage.
• NEW! Updated information addresses all health insurance topics, including key topics like Medicare and Electronic Health Records.
• NEW! More emphasis on electronic claims submission has been added.
• NEW! Updated figures, graphs, and tables summarize the latest health insurance information.
• Janet I. Beik, AA, BA, MEd, Southeastern Community College (retired), Administrative Instructor, Medical Assistant Program, West Burlington, IA, USA.
• Julie Pepper, BS, CMA (AAMA), Medical Assistant Instructor, Chippewa Valley Technical College, Eau Claire, Wisconsin