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Enhance your skills and establish a strong foundation for success with Green's UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2024 Edition. This practical, reader-friendly resource delivers an updated guide to current medical code sets and coding guidelines, equipping you to assign ICD-10-CM, CPT, and HCPCS Level II codes, complete health insurance claims and master revenue management concepts. Key areas covered include managed care, legal and regulatory matters, coding systems and compliance, reimbursement methods, clinical documentation improvement and coding for medical necessity and common health insurance plans. A workbook provides hands-on assignments and case studies, and MindTap online courseware offers interactive simulation for completing CMS-1500 claims and assigning codes.
List of contents
1. Health Insurance Specialist Career.
2. Introduction to Health Insurance and Managed Care.
3. Introduction to Revenue Management.
4. Revenue Management: Insurance Claims, Denied Claims and Appeals, 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
Enhance your skills and establish a strong foundation for success with Green's UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2024 Edition. This practical, reader-friendly resource delivers an updated guide to current medical code sets and coding guidelines, equipping you to assign ICD-10-CM, CPT®, and HCPCS Level II codes, complete health insurance claims and master revenue management concepts. Key areas covered include managed care, legal and regulatory matters, coding systems and compliance, reimbursement methods, clinical documentation improvement and coding for medical necessity and common health insurance plans. A workbook provides hands-on assignments and case studies, and MindTap online courseware offers interactive simulation for completing CMS-1500 claims and assigning codes.
