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'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.

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