Medical Insurance: A Revenue Cycle Process Approach ISE

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, bachelor’s degrees in both business administration and marketing from Lakeland College, and a master’s 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).

Part 1 WORKING WITH MEDICAL INSURANCE AND BILLING
Chapter 1 Introduction to the Revenue 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: ICD-10-CM
Chapter 5 Procedural Coding: CPT and HCPCS
Chapter 6 Visit Charges and Compliant Billing


Part 3 CLAIMS
Chapter 7 Healthcare Claim Preparation and Transmission
Chapter 8 Private Payers/ACA Plans
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