Preface Acknowledgments CHAPTER 1 From Patient to Payment: Understanding Medical Insurance 1.1 Working with Medical Insurance 1.2 Paying for Medical Services 1.3 The Medical Billing Cycle 1.4 Using PM/EHRs: The Integrated Medical Documentation and Billing Cycle 1.5 Set for Success Chapter Review CHAPTER 2 Electronic Health Records, HIPAA, and HITECH: Sharing and Protecting Patients'' Health Information 2.1 Medical Records and the Need for Accurate Documentation 2.2 Health Care Regulations 2.
3 HIPAA Privacy Rule 2.4 HIPAA Security Rule and HITECH Breach Notification Rule 2.5 HIPAA Electronic Health Care Transactions and Code Sets 2.6 Avoiding Fraud and Abuse 2.7 Compliance Plans Chapter Review CHAPTER 3 Patient Encounters and Billing Information 3.1 New Versus Established Patients 3.2 Information for New Patients 3.3 Information for Established Patients 3.
4 Verifying Patient Eligibility for Insurance Benefits 3.5 Determining Preauthorization and Referral Requirements 3.6 Determining the Primary Insurance 3.7 Working with Encounter Forms 3.8 Communications Are Key Chapter Review CHAPTER 4 Diagnostic Coding 4.1 ICD-10-CM 4.2 The Alphabetic Index 4.3 The Tabular List 4.
4 Using External Cause Codes and Z Codes 4.5 ICD-10-CM Official Guidelines for Coding and Reporting 4.6 Assigning Diagnosis Codes Chapter Review CHAPTER 5 Procedural Coding 5.1 Introduction to Procedure Codes in the CPT 5.2 Coding Steps 5.3 Coding Evaluation and Management Services 5.4 Coding Surgical Procedures 5.5 Coding Laboratory Procedures and Immunizations 5.
6 HCPCS Codes Chapter Review CHAPTER 6 Payment Methods and Checkout Procedures 6.1 Types of Health Plans 6.2 Methods for Setting Fees 6.3 Third-Party Contracts and Guidelines 6.4 Time-of-Service (TOS) Payments 6.5 Calculating TOS Payments 6.6 Checking Out Patients Chapter Review CHAPTER 7 Health Care Claim Preparation and Transmission 7.1 Preparing Claims Using Practice Management Programs 7.
2 Health Care Claims 7.3 Completing the CMS-1500 02/12 Claim 7.4 The HIPAA Claim 7.5 Health Care Claim Transmission 7.6 Billing Secondary Payers Chapter Review CHAPTER 8 Private Payers/BlueCross and BlueShield 8.1 Private Insurance 8.2 Major Private Payers and the BlueCross BlueShield Association 8.3 Billing Guidelines Under Participation Contracts 8.
4 Private Payer Claims 8.5 Capitation Management Chapter Review CHAPTER 9 Medicare 9.1 Medicare Overview 9.2 Part B Plans and Medigap Plans 9.3 Medicare Charges 9.4 Using the ABN 9.5 Medicare Secondary Payer 9.6 Claim Completion Chapter Review CHAPTER 10 Medicaid 10.
1 Introduction to Medicaid 10.2 Medicaid Coverage 10.3 Medicaid Eligibility and Plans 10.4 Filing Medicaid Claims Chapter Review CHAPTER 11 TRICARE and CHAMPVA 11.1 The TRICARE Program 11.2 Provider Participation and Nonparticipation 11.3 TRICARE Plans 11.4 TRICARE and Other Insurance Plans 11.
5 CHAMPVA 11.6 Filing Claims Chapter Review CHAPTER 12 Workers'' Compensation and Automobile/Disability Insurance 12.1 Federal Workers'' Compensation Plans 12.2 State Workers'' Compensation Plans 12.3 Workers'' Compensation Terminology 12.4 Claim Process 12.5 Automobile Insurance and Disability Compensation Programs Chapter Review CHAPTER 13 Claim Processing, Payments, and Collections 13.1 Health Plan Claim Processing by Payers 13.
2 Processing the Remittance Advice 13.3 Appeals 13.4 Patient Billing and Adjustments 13.5 Collecting Outstanding Patient Accounts 13.6 Writing Off Uncollectible Accounts 13.7 Terminating the Provider-Patient Relationship Chapter Review CHAPTER 14 Hospital Insurance 14.1 Health Care Facilities: Inpatient Versus Outpatient 14.2 Hospital Billing Cycle 14.
3 Inpatient (Hospital) Coding 14.4 Payers and Payment Methods 14.5 Claims and Follow Up Chapter Review CHAPTER 15 AVAILABLE AT WWW.MCGRAWHILLCREATE.COM Dental Insurance 15.1 Introduction to Dental Terms 15.2 Dental Insurance 15.3 Processing Dental Claims Chapter Review CHAPTER 16 AVAILABLE AT WWW.
MCGRAWHILLCREATE.COM Diagnostic Coding: Introduction to ICD-9-CM and ICD-10-CM 16.1 ICD-9-CM 16.2 Organization of ICD-9-CM 16.3 The Alphabetic Index 16.4 The Tabular List 16.5 Tabular List of Chapters 16.6 V Codes and E Codes 16.
7 Coding Steps 16.8 Official Coding Guidelines 16.9 Introducing ICD-10-CM Chapter Review Appendix A Guide to Medisoft Appendix B Guide to the Interactive Simulated CMS-1500 Form Appendix C Professional Websites Appendix D Forms Abbreviations Glossary Index.