Learn to comprehend the complexities of health insurance! Using a reader-friendly approach, Health Insurance Today, A Practical Approach, 6th Edition gives you a solid understanding of health insurance, its types and sources, and the ethical and legal issues surrounding it. This new edition incorporates the latest information surrounding ICD-10, the Patient Protection and Affordable Care Act, and other timely federal influencers, as it guides you through the important arenas of health insurance such as claims submission methods, the claims process, coding, reimbursement, hospital billing, and more. Plus, with hands-on UB-04 and CMS-1500 (02-12) case studies on Evolve, you will come away with a clear understanding and working knowledge of the latest advances and issues in health insurance.
- CMS-1500 (02-12) software with case studies gives you hands-on practice filling in a CMS-1500 (02-12) form electronically.
- What Did You Learn? review questions ensure you understand the material already presented before moving on to the next section.
- Imagine This! scenarios help you understand how information in the book applies to real-life situations.
- Stop and Think exercises challenge you to use your critical thinking skills to solve a problem or answer a question.
- Clear, attainable learning objectives help you focus on the most important information and make chapter content easier to teach.
- Chapter summaries relate to learning objectives, provide a thorough review of key content, and allow you to quickly find information for further review.
- Direct, conversational writing style makes reading fun and concepts easier to understand.
- HIPAA tips emphasize the importance of privacy and following government rules and regulations.
- NEW! Updated content on the latest advances covers the most current information on Medicare, Electronic Health Records, Version 5010, and much more.
- NEW! Expanded ICD-10 coverage and removal of all ICD-9 content ensures you stay up-to-date on these significant healthcare system changes.
- NEW! UB-04 software and case studies gives you hands-on practice filling out electronic UB-04 forms.
- NEW! UNIQUE! SimChart® for the Medical Office case studies gives you additional real-world practice.
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. Healthcare Reform: Coverage Types and Sources
Unit 2: Health Insurance Basics
5. Claim Submission Methods
6. New and Traditional Reimbursement Methods
7. The Changing Face 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