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List of contents
1. Health Insurance Specialist Career.
2. Introduction to Health Insurance and Managed Care.
3. Introduction to Revenue Management.
4. Revenue Management of the Insurance Claim Cycle, Maintaining Insurance Claim Files, and Credit and Collections.
5. Legal Aspects of Health Insurance and Reimbursement.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding Compliance, Clinical Documentation Improvement, and Coding for Medical Necessity.
11. CMS-1500 and UB-04 Claims.
12. Commercial Insurance.
13. BlueCross BlueShield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers’ Compensation.
Appendices.
Bibliography.
Glossary.
Index.
About the author
Michelle Green has served as a full-time or adjunct faculty member since 2017. During Spring 2023, Green was named interim Program Director in the Health Information Technology department at Mohawk Valley Community College in Utica, New York. She was the SUNY Distinguished Teaching Professor in the Physical and Life Sciences department at the State University of New York College of Technology at Alfred for over 30 years. She has authored three popular textbooks related to coding, revenue management and health information management. An active member of the AAPC and American Health Information Management Association, Green has been recognized for her excellence in teaching as well as her significant contributions to the health information management profession. Her numerous accolades include the State University of New York Chancellor's Award for Excellence in Teaching, Alfred State College's Alumni Association Teacher of the Year, Who's Who Among America's Teachers, AHIMA's FORE Triumph Educator Award and NYHIMA’s Educator Award. In addition, she is a Registered Health Information Administrator, a fellow of the American Health Information Management Association and a Certified Professional Coder. She earned an MPS from Alfred University and a Bachelor of Science from Daemen College.
Summary
Strengthen your skills and develop a solid foundation in medical insurance processing and revenue management with Green's UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2022 Edition. This reader-friendly, comprehensive resource explains the latest developments and medical code sets and coding guidelines as you learn how to assign ICD-10-CM, CPT® 2022 codes and HCPCS level II codes, complete health care claims and master revenue management concepts. You focus on important topics such as the latest managed care, legal and regulatory issues, coding systems and compliance, reimbursement methods, clinical documentation improvement, coding for medical necessity and common health insurance plans. New material introduces electronic claims, performance measurement and processing clinical quality language. A helpful workbook provides hands-on assignments and case studies, while MindTap online resources offer practice in CMS-1500 claims completion and assigning codes.
