Medical Insurance: A Revenue Cycle Process Approach

Nenna L. Bayes , AAS, BBA, M.Ed., CPC, has coauthored and reviewed various titles within the medical administrative fields. She earned an associate of applied business degree, a bachelor of business administration degree, and a masters of arts in education from Morehead State University. During her tenure, she has taught numerous courses within the administrative and medical administrative curriculum. She is a professor in and the program coordinator for the Office Systems Technology and Medical Information Technology programs at Ashland Community and Technology College in Ashland, Kentucky, and has received many teaching excellence awards. She is also a certified professional coder (CPC). Prior to teaching, she worked in various medical office environments. Additionally, she is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA). She lives in Flatwoods, Kentucky, with her husband and is blessed to have two children and two granddaughters . She is actively involved in music and enjoys camping in her leisure time. Cynthia Newby, CPC, CPC-P, is a long-serving author who works closely with McGraw-Hill Education instructional development staff to develop excellent MIBC programs. Cynthia is a graduate of Hood College and a trustee of that institution as well as her local animal shelter and library. Amy L. Blochowiak, MBA, RHIT, ACS, AIAA, AIRC, ARA,FLHC, FLMI, HCSA, HIA, HIPAA, MHP, PCS, SILA-F, has coauthored and reviewed various textbooks within the medical administrative and insurance fields. She earned associate degrees in medical office mid-management and health information technology from Northeast Wisconsin Technical College, bachelors degrees in both business administration and marketing from Lakeland College, and a masters degree in business administration from Lakeland College. She is currently the program director and instructor for the Healthcare Business Professional program at Northeast Wisconsin Technical College, where she sits on many committees and shares her passion for student success. Prior to teaching, she worked in various insurance industry roles for over 16 years. She is a member of the American Health Information Management Association (AHIMA).

Preface AcknowledgmentsPart 1 WORKING WITH MEDICAL INSURANCE AND BILLING Chapter 1-Introduction to the Medical Billing Cycle Chapter 2- Electronic Health Records, HIPAA, and HITECH: Sharing and Protecting Patients' Health Information Chapter 3-Patient Encounters and Billing Information Part 2 CLAIM CODING Chapter 4- Diagnostic Coding: Introduction to ICD-10-CM Chapter 5- Procedural Coding: CPT and HCPCS Chapter 6-Visit Charges and Compliant Billing Part 3 CLAIMS Chapter 7-Health Care Claim Preparation and Transmission Chapter 8-Private Payers/BlueCross BlueShield Chapter 9-Medicare Chapter 10-Medicaid Chapter 11- TRICARE and CHAMPVA Chapter 12-Workers' Compensation and Disability/Automotive Insurance Part 4 CLAIM FOLLOW-UP AND PAYMENT PROCESSING Chapter 13-Payments (RAs), Appeals, and Secondary Claims Chapter 14-Patient Billing and Collections Chapter 15- Primary Case Studies Chapter 16-RA/Secondary Case Studies Part 5 HOSPITAL SERVICES Chapter 17-Hospital Billing and Reimbursement Part 6 CLAIM CODING: ICD-9-CMChapter 18-Diagnostic Coding: Introduction to ICD-9-CM and ICD-10-CM Appendix A Guide to Medisoft Appendix B Guide to the Interactive Simulated CMS-1500 Form Appendix C Place of Service Codes Appendix D Professional Websites Appendix E Forms Abbreviations Glossary Index