Solutions for Medical Insurance: A Revenue Cycle Process Approach
Browse All Chapters of This Textbook
Chapter 1 - Introduction To The Revenue CycleChapter 1.1 - Working In The Medical Insurance FieldChapter 1.2 - Medical Insurance BasicsChapter 1.3 - Healthcare PlansChapter 1.4 - Health Maintenance OrganizationsChapter 1.5 - Preferred Provider OrganizationsChapter 1.6 - Consumer-driven Health PlansChapter 1.7 - Medical Insurance PayersChapter 1.8 - The Revenue CycleChapter 1.9 - Achieving Success
Chapter 1.10 - Moving AheadChapter 2 - Electronic Health Records, Hipaa, And Hitech: Sharing And Protecting Patients' Health InformationChapter 2.1 - Medical Record Documentation: Electronic Health RecordsChapter 2.2 - Healthcare Regulation: Hipaa,hitech, And AcaChapter 2.3 - Covered Entities And Business AssociatesChapter 2.4 - Hipaa Privacy RuleChapter 2.5 - Hipaa Security RuleChapter 2.6 - Hitech Breach Notification RuleChapter 2.7 - Hipaa Electronic Health Care Transactions And Code SetsChapter 2.8 - Omnibus Rule And EnforcementChapter 2.9 - Fraud And Abuse RegulationsChapter 2.10 - Compliance PlansChapter 3 - Patient Encountes And Billing InformationChapter 3.1 - New Versus Established PatientsChapter 3.2 - Information For New PatientsChapter 3.3 - Information For Established PatientsChapter 3.4 - Verifying Patient Eligibility For Insurance BenefitsChapter 3.5 - Determining Preauthorization And Referral RequirementsChapter 3.6 - Determining The Primary InsuranceChapter 3.7 - Working With Encounter FormsChapter 3.8 - Understanding Time-of-service (tos) PaymentsChapter 3.9 - Calculating Tos PaymentsChapter 4 - Diagnostic Coding: Icd-10-cmChapter 4.1 - Icd-10-cmChapter 4.2 - Organization Of Icd-10-cmChapter 4.3 - The Alphabetic IndexChapter 4.4 - The Tabular ListChapter 4.5 - Icd-10-cm Official Guidelines For Coding And ReportingChapter 4.6 - Overview Of Icd-10-cm ChaptersChapter 4.7 - Coding StepsChapter 5 - Procedural Coding: Cpt And HcpcsChapter 5.1 - Current Procedural Terminology, Fourth Edition (cpt)Chapter 5.2 - OrganizationChapter 5.3 - Format And SymbolsChapter 5.4 - Cpt ModifiersChapter 5.5 - Coding StepsChapter 5.6 - Evaluation And Management CodesChapter 5.7 - Anesthesia CodesChapter 5.8 - Surgery CodesChapter 5.9 - Radiology CodesChapter 5.10 - Pathology And Laboratory CodesChapter 5.11 - Medicine CodesChapter 5.12 - Category Ii And Iii CodesChapter 5.13 - HcpcsChapter 6 - Visit Charges And Compliant BillingChapter 6.1 - Compliant BillingChapter 6.2 - Knowledge Of Billing RulesChapter 6.3 - Compliance ErrorsChapter 6.4 - Strategies For ComplianceChapter 6.5 - AuditsChapter 6.6 - Physician FeesChapter 6.7 - Payer Fee SchedulesChapter 6.8 - Calculating Rbrvs PaymentsChapter 6.9 - Fee-based Payment MethodsChapter 6.10 - CapitationChapter 6.11 - Collecting Tos Payments And Checking Out PatientsChapter 7 - Healthcare Claim Preparation And TransmissionChapter 7.1 - Introduction To Healthcare ClaimsChapter 7.2 - Completing The Cms-1500 Claim: Patient Information SectionChapter 7.3 - Types Of ProvidersChapter 7.4 - Completing The Cms-1500 Claim: Physician/supplier Information SectionChapter 7.6 - Completing The Hipaa 837p ClaimChapter 7.7 - Checking Claims Before TransmissionChapter 7.8 - Clearinghouses And Claim TransmissionChapter 8 - Private Payers/aca PlansChapter 8.1 - Group Health PlansChapter 8.2 - Types Of Private PayersChapter 8.3 - Consumer-driven Health PlansChapter 8.4 - Major Private Payers And The Bluecross Blueshield AssociationChapter 8.5 - Affordable Care Act (aca) PlansChapter 8.6 - Participation ContractsChapter 8.7 - Interpreting Compensation And Billing GuidelinesChapter 8.8 - Private Payer Billing Management: Plan Summary GridsChapter 8.9 - Preparing Correct ClaimsChapter 8.10 - Capitation ManagementChapter 9 - MedicareChapter 9.1 - Eligibility For MedicareChapter 9.2 - The Medicare ProgramChapter 9.3 - Medicare Coverage And BenefitsChapter 9.4 - Medicare Participating ProvidersChapter 9.5 - Nonparticipating ProvidersChapter 9.6 - Original Medicare PlanChapter 9.7 - Medicare Advantage PlansChapter 9.10 - Preparing Primary Medicare ClaimsChapter 10 - MedicaidChapter 10.2 - EligibilityChapter 10.3 - State ProgramsChapter 10.4 - Medicaid Enrollment VerificationChapter 10.5 - Covered And Excluded ServicesChapter 10.6 - Plans And PaymentsChapter 10.7 - Third-party LiabilityChapter 10.8 - Claim Filing And Completion GuidelinesChapter 11 - Tricare And ChampvaChapter 11.1 - The Tricare ProgramChapter 11.2 - Provider Participation And NonparticipationChapter 11.3 - Tricare PlansChapter 11.4 - Tricare And Other Insurance PlansChapter 11.5 - ChampvaChapter 11.6 - Filing ClaimsChapter 12 - Workers’ Compensation And Disability/automotive InsuranceChapter 12.1 - Federal Workers’ Compensation PlansChapter 12.2 - State Workers’ Compensation PlansChapter 12.3 - Workers’ Compensation TerminologyChapter 12.4 - Claim ProcessChapter 12.5 - Disability Compensation And Automotive Insurance ProgramsChapter 13 - Payments (ras), Appeals, And Secondary ClaimsChapter 13.1 - Claim AdjudicationChapter 13.2 - Monitoring Claim StatusChapter 13.3 - The Remittance Advice (ra)Chapter 13.4 - Reviewing RasChapter 13.5 - Procedures For PostingChapter 13.7 - Postpayment Audits, Refunds, And GrievancesChapter 13.8 - Billing Secondary PayersChapter 13.9 - The Medicare Secondary Payer (msp) Program, Claims, And PaymentsChapter 14 - Patient Billing And CollectionsChapter 14.1 - Patient Financial ResponsibilityChapter 14.2 - Working With Patients’ StatementsChapter 14.3 - The Billing CycleChapter 14.4 - Organizing For Effective CollectionsChapter 14.5 - Collection Regulations And ProceduresChapter 14.6 - Credit Arrangements And Payment PlansChapter 14.7 - Collection Agencies And Credit ReportingChapter 14.8 - Writing Off Uncollectible AccountsChapter 14.9 - Record RetentionChapter 16 - Ra/secondary Case StudiesChapter 17 - Hospital Billing And ReimbursementChapter 17.1 - Healthcare Facilities: Inpatient Versus OutpatientChapter 17.2 - Hospital Billing CycleChapter 17.3 - Hospital Diagnosis CodingChapter 17.4 - Hospital Procedure CodingChapter 17.5 - Payers And Payment MethodsChapter 17.6 - Claims And Follow-upChapter 18 - Diagnostic Coding: Introduction To Icd-9-cm And Icd-10-cmChapter 18.1 - Icd-9-cmChapter 18.2 - Organization Of Icd-9-cmChapter 18.3 - The Alphabetic IndexChapter 18.4 - The Tabular ListChapter 18.5 - Tabular List Of ChaptersChapter 18.6 - V Codes And E Codes
Book Details
The seventh edition of Medical Insurance: An Integrated Claims Process Approach emphasizes the medical billing cycle-ten steps that clearly identify all the components needed to successfully manage the medical insurance claims process. The cycle shows how administrative medical professionals "follow the money." Medical insurance specialists must be familiar with the rules and guidelines of each health plan in order to submit proper documentation, which then ensures that offices receive maximum, appropriate reimbursement for services provided. Learn the skills you need for your health professions career using multiple digital resources. The claims case studies can be completed via CMS-1500 form activities or by using simulated Medisoft exercises, both available in Connect, McGraw-Hill Education's homework and assessment platform. Read and study the content more effectively-spending more time on topics you don't know and less time on the topics you do-by using LearnSmart and SmartBook, McGraw-Hill's revolutionary adaptive learning technology.
Sample Solutions for this Textbook
We offer sample solutions for Medical Insurance: A Revenue Cycle Process Approach homework problems. See examples below:
The medical insurance specialists have a significant role in managing the revenue cycle: Following...The medical records are shaped depends on a various kind of documentation for meetings of patient to...The methods used to classify patients as new or established is as follows: To accumulate precise...ICD-10 codes are alphanumerical codes that are used to signify diagnoses by physicians, health...Current Procedural Terminology, more, for the most part, alluded to as CPT, alludes to a collection...Importance: Code linkage refers to the connection between the illness of the patient and the...Electronic claim: Electronic Data Interchange (EDI) implies the trade of trade transactions from one...The main characteristics of group health plan is as follows: Group health plan implement and control...One must be eligible under any 1 of the 6 beneficiary kinds: Disabled adults. of age or older who...
The purpose of Medicaid program is as follows: The main purpose is to pay for the health care...TRICARE is a health program for: Uniformed Service members and their families, National...The 4 emolument plans for laborers which give cover for government representatives are: The Federal...Upon filling a medical report, the insurance firm decides the financial liability for payment to the...Medical practices generally use various methods to inform the patients regarding their financial...In arrange to form secondary claims in Medisoft, you would like to memorize how to enter and apply...Inpatient services: The inpatient services are offered by skilled nursing amenities, long term care...ICD-9-CM is used to label and identify morbidity data from inpatient and outpatient reports,...
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