Overview

"Medical Reimbursement: A Contextualized Method helps students navigate through the ins and outs of medical billing. An understanding of medical insurance and related terms is essential to the medical billing process. Healthcare is very expensive for a variety of reasons and, to remain profitable, medical providers must manage their ""business"" with the help of qualified employees who understand insurance benefits and the responsibility of reimbursement. Simply having medical insurance coverage does not necessarily mean that insurance will pay for all, or even part, of healthcare expenses. Some individuals by their own choice or by unforeseen circumstances, do not have insurance and are considered to be self-insured (or self-pay patients) and are, therefore, responsible for the entire cost of their own healthcare expenses."

Full Product Details

Author:   Julie Ledbetter
Publisher:   Kendall/Hunt Publishing Co ,U.S.
Imprint:   Kendall/Hunt Publishing Co ,U.S.
Edition:   4th Revised edition
ISBN:  

9781792468513

ISBN 10:   1792468512
Pages:   277
Publication Date:   30 May 2021
Audience:   College/higher education ,  Tertiary & Higher Education
Format:   Paperback
Publisher's Status:   Active
Availability:   Temporarily unavailable  
The supplier advises that this item is temporarily unavailable. It will be ordered for you and placed on backorder. Once it does come back in stock, we will ship it out to you.

Table of Contents

CHAPTER 1: INTRODUCTION TO MEDICAL INSURANCE Health Insurance History Types of Payers Managed Care Health Maintenance Organizations Preferred Provider Organizations Consumer-Driven Health Plans Government Payers Medicare Medicaid Tricare ChampVA Workers' Compensation CHAPTER 2: LAWS AND REGULATORY REQUIREMENTS Health Insurance Portability and Accountability Act Federal False Claims Act Civil Monetary Penalties Law Patient Protection and Aff ordable Care Act CHAPTER 3: DOCUMENTING MEDICAL CARE Patient Encounters Medical Coding Procedures and Services (CPT) Coding Guidelines for CPT coding Diagnoses Coding Guidelines for ICD-10-CM coding Diagnosis-Related Groups Procedure 3-1 Patient Encounters Procedure 3-2 Completing a Preauthorization Procedure 3-3 Completing a Precertification CHAPTER 4: PROFESSIONAL FEES AND REIMBURSEMENT Practice Fee Schedules Payer Reimbursement Resource-based Relative Value Scale Capitation Discounted Fee-for-Service Transformation of Health care Reimbursement Procedure 4-1 Creating a Fee Schedule CHAPTER 5: PRIVATE PAYERS Group Health Plans Managed Care Plans Procedure 5-1 Interpreting Insurance Information CHAPTER 6: THE HEALTH INSURANCE CLAIM FORM CMS-1500 Claim Form Primary Claims Secondary Payers Procedures 6-1, 6-2, 6-3, 6-4 Preparing Primary CMS-1500 Claims Procedure 6-5 Preparing Secondary CMS-1500 Claim CHAPTER 7: GOVERNMENT PAYERS AND WORKERS' COMPENSATION Medicare Medicaid Workers' Compensation Tricare CHAMPVA Procedure 7-1 Preparing Workers' Compensation CMS-1500 Claim Procedure 7-2 Preparing Medicare CMS-1500 Claim CHAPTER 8: INTRODUCTION TO BOOKKEEPING Procedure 8-1 Posting Charges to Ledgers CHAPTER 9: REIMBURSEMENT FOR HEALTH CARE SERVICES Posting Insurance Payments Insurance Math Guidelines Procedure 9-1 Posting Payments to Day Sheet CHAPTER 10: ACCOUNT BALANCES AND GUARANTOR RESPONSIBILITY Patient Statements Procedure 10-1 Creating Patient Statements CHAPTER 11: DELINQUENT ACCOUNTS, COLLECTIONS, AND REFUNDS Delinquent Accounts Collection Agency Payments Nonsufficient Funds Payments Refunds Procedure 11-1 Posting Refunds and Delinquent Transactions CHAPTER 12: BANKING SERVICES Accounts Receivable Accounts Payable Procedure 12-1 Posting to the Disbursement Journal Procedure 12-2 Completing a Deposit Slip CHAPTER 13: RECONCILIATION OF ACCOUNTS Procedure 13-1 Reconciling a Bank Statement Procedure 13-2 Posting Transactions and Reconciling a Day Sheet Physicians Healthcare Services Participating Provider Fee Schedule Procedure 13-2 CHAPTER 14: MISCELLANEOUS PRACTICE EXPENSES Petty Cash Procedure 14-1 Completing Petty Cash Vouchers Procedure 14-2 Completing Petty Cash Report Objective: Prepare an Accurate Petty Cash Report Procedure 14-3 Replenishing Petty Cash CHAPTER 15: PAYROLL Payroll Responsibilities Payroll Processing Procedure 15-1 Calculating Payroll

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