A comprehensive, approachable guide to hospital insurance billing and coding, Understanding Hospital Billing and Coding, 2nd Edition covers everything hospital billers need to know, from patient admission to accounts receivable management and HIPAA. It builds on your knowledge so that you can make a successful transition from the physician/outpatient environment to the hospital setting. Written by coding expert Debra P. Ferenc, this book covers the hospital regulatory setting, the structure and functions of hospital departments, patient accounts and data flow, the billing process, coding, claim forms, reimbursement, accounts receivable management, HIPAA requirements, and much more.
- UB-04 Claim Simulation on the companion Evolve website lets you practice entering information from source documents into the claim form.
- Over 300 illustrations and graphics bring important concepts to life.
- Detailed chapter objectives highlight what you are expected to learn.
- Key terms, acronyms, and abbreviations with definitions are included in each chapter.
- Concept Review boxes reinforce key concepts.
- Test Your Knowledge exercises reinforce lessons as you progress through the material.
- Chapter summaries review key concepts.
- Practice hospital cases let you apply concepts to real-life scenarios.
- UPDATED content reflects the most current industry changes in ICD-10, MR-DRGs, PPS Systems, and the Electronic Health Record.
- NEW Hospital Introduction chapter includes a department-by-department overview showing how today’s hospitals really work
- NEW Health Care Payers and Reimbursement section follows the workflow of the hospital claim by including successive chapters on payers, prospect payment systems, and accounts receivable management.
Section 1: Hospital Overview
1. Hospital Introduction
2. Hospital Regulatory Environment
Section 2: Hospital Billing and Coding Process
4. Patient Accounts Data Flow
5. Hospital Billing Process
Section 3: Coding
6. ICD-9-CM Diagnosis and Procedure Coding
7. ICD-10-CM Diagnosis Coding
8. Procedure Coding (HCPCS and ICD-10-PCS)
9. Coding Guidelines and Applications (HCPCS and ICD-10-CM/PCS)
Section 4: Claim Forms
10. Claim Forms
Section 5: Health Care Payers and Reimbursement
12. Prospective Payment Systems
13. Accounts Receivable Management
Section 6: Appendixes
B: Claim Form Data
C: Web Resources