Beik's Health Insurance Today
- 8th Edition - September 14, 2023
- Author: Julie Pepper
- Language: English
- Paperback ISBN:9 7 8 - 0 - 3 2 3 - 8 8 4 0 0 - 6
- eBook ISBN:9 7 8 - 0 - 3 2 3 - 9 3 4 1 0 - 7
**Selected for Doody’s Core Titles® 2024 in Managed Care**Master the complexities of health insurance with this easy-to-understand guide! Beik’s Health Insurance Today, 8th Editi… Read more
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Request a sales quote**Selected for Doody’s Core Titles® 2024 in Managed Care**
Master the complexities of health insurance with this easy-to-understand guide! Beik’s Health Insurance Today, 8th Edition provides a solid foundation in basics such as the types and sources of health insurance, the submission of claims, and the ethical and legal issues surrounding insurance. It follows the claims process from billing and coding to reimbursement procedures, with realistic practice on the Evolve companion website. This edition adds up-to-date coverage of cybersecurity, COVID-19, crowdfunding for medical bills, and cost/value calculators. Making difficult concepts seem anything but, this resource prepares you for a successful career as a health insurance professional.
- Direct, conversational writing style makes learning insurance and billing concepts easier.
- Clear and attainable learning objectives, with chapter content that follows the order of the objectives, make learning easier for students and make chapter content easier to teach for educators.
- Learning features include review questions, scenarios, and additional exercises to ensure comprehension, critical thought, and application to practice.
- Hands-on practice with a fillable CMS-1500 form and accompanying case studies and unique UB-04 forms on the companion Evolve website, ensure practicum- and job-readiness.
- HIPAA Tips emphasize the importance of privacy and government rules and regulations, ensuring a solid foundation in regulatory compliance.
- Cover image
- Title page
- Copyright
- Contents
- List of Contributors
- Preface
- About the Author
- A Word About HIPAA
- 1. The Origins of Health Insurance
- WHAT IS INSURANCE?
- HISTORY
- METAMORPHOSIS OF HEALTH INSURANCE
- KEY HEALTH INSURANCE ISSUES
- BASIC HEALTH INSURANCE PLANS
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 2. Tools of the Trade: A Career as a Health Insurance Professional
- YOUR FUTURE AS A HEALTH INSURANCE PROFESSIONAL
- JOB DUTIES AND RESPONSIBILITIES
- CAREER PROSPECTS
- OCCUPATIONAL TRENDS AND FUTURE OUTLOOK
- WHAT TO EXPECT AS A HEALTH INSURANCE PROFESSIONAL
- REWARDS
- IS A CAREER IN HEALTHCARE RIGHT FOR YOU?
- CERTIFICATION POSSIBILITIES
- CAREER FOCUS FOR THE HEALTH INSURANCE PROFESSIONAL
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 3. The Legal and Ethical Side of Health Insurance
- MEDICAL LAW AND LIABILITY
- INSURANCE AND CONTRACT LAW
- MEDICAL LAW, ETHICS, AND ETIQUETTE AS APPLICABLE TO HEALTH INSURANCE
- MEDICAL ETIQUETTE
- IMPORTANT LEGISLATION AFFECTING HEALTH INSURANCE
- HEALTH RECORD
- DOCUMENTATION AND MAINTENANCE OF PATIENT HEALTH RECORDS
- HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT AND COMPLIANCE
- CONFIDENTIALITY AND PRIVACY
- HEALTHCARE FRAUD AND ABUSE
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 4. Healthcare Reform: Coverage Types and Sources
- THE CHANGING FACE OF HEALTH INSURANCE
- THE HEALTH INSURANCE MARKETPLACE
- MAJOR HEALTHCARE PAYERS
- MISCELLANEOUS HEALTHCARE COVERAGE OPTIONS
- CMS-1500 CLAIM FORM
- CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT
- HEALTH INSURANCE “WATCHDOGS”
- OTHER TERMS COMMON TO THIRD-PARTY CARRIERS
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 5. The Patient and the Billing Process
- PATIENT EXPECTATIONS
- FUTURE TRENDS
- HIPAA REQUIREMENTS
- BILLING POLICIES AND PRACTICES
- BILLING AND COLLECTION
- LAWS AFFECTING CREDIT AND COLLECTION
- COLLECTION TECHNIQUES
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 6. Reimbursement Models
- TYPES OF HEALTH INSURANCE
- MINIMUM ESSENTIAL COVERAGE AND THE MARKETPLACE
- STANDARD COSTS ASSOCIATED WITH INSURANCE PLANS
- HOW FEES ARE DETERMINED
- THE CHANGING STRUCTURE OF HEALTHCARE IN THE UNITED STATES
- THE AFFORDABLE CARE ACT AND PREEXISTING CONDITIONS
- THE AFFORDABLE CARE ACT AND HIPAA
- COMMERCIAL OR PRIVATE HEALTH INSURANCE
- LARGEST COMMERCIAL INSURANCE COMPANIES
- SUBMITTING COMMERCIAL CLAIMS
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW
- WEBSITES TO EXPLORE
- 7. Understanding Managed Care
- WHAT IS MANAGED CARE?
- ORIGINS OF MANAGED CARE
- GOALS OF MANAGED CARE
- THE CHANGING FACE OF MANAGED CARE
- MANAGED CARE’S CHALLENGES
- TYPES OF MANAGED CARE ORGANIZATIONS
- MANAGED CARE AND GOVERNMENT-SPONSORED HEALTH PLANS
- MANAGED CARE AND HIPAA
- MANAGED CARE AND THE AFFORDABLE CARE ACT
- MANAGED CARE ACCREDITATION AND REGULATION
- CLAIMS MANAGEMENT
- IMPACT OF MANAGED CARE
- FUTURE OF MANAGED CARE
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 8. Understanding Medicare
- THE MEDICARE PROGRAM
- THE EFFECTS OF THE ACA ON MEDICARE COVERAGE
- MEDICARE COMBINATION COVERAGES
- MEDICARE AND MANAGED CARE
- PREPARING FOR THE MEDICARE PATIENT
- MEDICARE BILLING
- FILING MEDICARE CLAIMS
- USING THE CMS-1500 FORM FOR MEDICARE CLAIMS
- MEDICARE SUMMARY NOTICE AND REMITTANCE ADVICE
- MEDICARE AUDITS AND APPEALS
- QUALITY REVIEW STUDIES
- MEDICARE BILLING FRAUD
- CLINICAL LABORATORY IMPROVEMENT AMENDMENTS PROGRAM
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 9. Understanding Medicaid
- WHAT IS MEDICAID?
- MEDICAID AND HEALTHCARE REFORM
- MEDICAID BENEFITS
- DUAL ELIGIBLE BENEFICIARIES
- OTHER MEDICAID PROGRAMS
- MEDICAID PREMIUMS AND COST-SHARING
- PRESCRIPTION DRUGS
- EMERGENCY MEDICAL TREATMENT AND LABOR ACT
- ACCEPTING MEDICAID PATIENTS
- MEDICARE/MEDICAID RELATIONSHIP
- PROCESSING MEDICAID CLAIMS
- MEDICAID AND THIRD-PARTY LIABILITY
- MEDICAID REMITTANCE ADVICE
- SPECIAL BILLING NOTES
- FRAUD AND ABUSE IN THE MEDICAID SYSTEM
- MEDICAID QUALITY PRACTICES
- THE HEALTH INSURANCE PROFESSIONAL’S ROLE
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 10. Understanding Military Carriers
- MILITARY HEALTH PROGRAMS
- TRICARE
- TRICARE’s ADDITIONAL COVERAGE OPTIONS
- VERIFYING TRICARE ELIGIBILITY
- TRICARE PROVIDER TYPES
- TRICARE BENEFICIARY COST-SHARING
- TRICARE CLAIMS PROCESSING
- CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERANS AFFAIRS
- CHAMPVA PROGRAM OPTIONS AND BENEFITS
- FILING CHAMPVA CLAIMS
- CHAMPVA Explanation of Benefits
- MILITARY CARRIERS AND HIPAA
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 11. Understanding Miscellaneous Carriers: Workers’ Compensation and Disability Insurance
- WORKERS’ COMPENSATION
- HIPAA AND WORKERS’ COMPENSATION
- PRIVATE AND EMPLOYER-SPONSORED DISABILITY INCOME INSURANCE
- FEDERAL DISABILITY PROGRAMS
- SSI Work Incentives
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 12. Claim Submission Methods
- OVERVIEW OF THE HEALTH INSURANCE CLAIMS SUBMISSION PROCESS
- ELECTRONIC CLAIMS
- HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
- HIPAA VERSION 5010 TRANSACTIONS AND CODE STANDARDS
- THE ELECTRONIC INSURANCE CLAIMS PROCESS
- ADVANTAGES OF ELECTRONIC CLAIMS
- TWO WAYS TO SUBMIT ELECTRONIC CLAIMS
- THE UNIVERSAL CLAIM FORM (CMS-1500)
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW
- WEBSITES TO EXPLORE
- 13. Diagnostic Coding
- INTRODUCTION TO THE INTERNATIONAL CLASSIFICATION OF DISEASES CODING SYSTEM
- HISTORY AND DEVELOPMENT OF THE INTERNATIONAL CLASSIFICATION OF DISEASES CODING SYSTEM
- PROCESS OF CLASSIFYING DISEASES
- OVERVIEW OF THE ICD-10 CODING SYSTEM
- ICD-10-CM Code Structure
- CODING STEPS FOR THE ALPHABETIC INDEX
- TABULAR LIST
- NEC (not elsewhere classifiable)
- NOS (not otherwise specified)
- ICD-10-CM OFFICIAL GUIDELINES FOR CODING AND REPORTING
- OTHER CODING FEATURES OF THE ICD-10-CM
- CODING STEPS FOR THE TABULAR LIST
- HIPAA AND CODING
- GENERAL EQUIVALENCE MAPPINGS
- LOOKING AHEAD TO ICD-11
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 14. Procedural, Evaluation and Management, and HCPCS Coding
- OVERVIEW OF CURRENT PROCEDURAL TERMINOLOGY CODING
- TWO LEVELS OF PROCEDURAL CODING
- CURRENT PROCEDURAL TERMINOLOGY MANUAL FORMAT
- CONVENTIONS AND PUNCTUATION USED IN CURRENT PROCEDURAL TERMINOLOGY
- BASIC STEPS OF CURRENT PROCEDURAL TERMINOLOGY CODING
- EVALUATION AND MANAGEMENT CODING
- SUBHEADINGS OF MAIN EVALUATION AND MANAGEMENT SECTION
- EVALUATION AND MANAGEMENT MODIFIERS
- IMPORTANCE OF DOCUMENTATION
- OVERVIEW OF HCPCS
- NATIONAL CORRECT CODING INITIATIVE
- HIPAA AND HCPCS CODING
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 15. Claims Management
- OVERVIEW OF THE CLAIMS MANAGEMENT PROCESS
- KEYS TO SUCCESSFUL CLAIMS
- HIPAA AND NATIONAL STANDARD EMPLOYER IDENTIFICATION NUMBER
- CLAIMS PROCESS
- PROCESSING SECONDARY CLAIMS
- OPTIMIZING THE BILLING AND CLAIMS PROCESS
- APPEALS
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 16. The Role of Computers in Health Insurance
- INTRODUCTION
- IMPACT OF COMPUTERS ON HEALTH INSURANCE
- ROLE OF HIPAA IN ELECTRONIC TRANSMISSIONS
- ELECTRONIC DATA INTERCHANGE
- ELECTRONIC CLAIMS PROCESS
- MEDICARE AND ELECTRONIC CLAIMS SUBMISSION
- ADDITIONAL ELECTRONIC SERVICES AVAILABLE
- ELECTRONIC HEALTH RECORD
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 17. Reimbursement Procedures: Getting Paid
- UNDERSTANDING REIMBURSEMENT SYSTEMS
- MEDICARE AND REIMBURSEMENT
- ADDITIONAL SYSTEMS FOR DETERMINING REIMBURSEMENT
- TRANSITION OF MEDICARE TO A RESOURCE-BASED RELATIVE VALUE SCALE
- SIGNIFICANCE OF REIMBURSEMENT SYSTEMS TO THE HEALTH INSURANCE PROFESSIONAL
- QUALITY IMPROVEMENT ORGANIZATIONS AND PROSPECTIVE PAYMENT SYSTEMS
- UNDERSTANDING COMPUTERIZED PATIENT ACCOUNTING SYSTEMS
- HIPAA AND PRACTICE MANAGEMENT SOFTWARE
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- 18. Hospital Billing and the UB-04
- INTRODUCTION
- HOSPITALS AND HEALTH SYSTEMS
- COMMON HEALTHCARE FACILITIES
- LEGAL AND REGULATORY ENVIRONMENT
- COMMON HOSPITAL PAYERS AND THEIR CLAIMS GUIDELINES
- NATIONAL UNIFORM BILLING COMMITTEE AND THE UB-04
- STRUCTURE AND CONTENT OF THE HOSPITAL HEALTH RECORD
- INPATIENT HOSPITAL/FACILITY CODING
- ICD-10-CM Code Sets Used for Inpatient Hospital/Facility Claims
- OUTPATIENT HOSPITAL CODING
- THE HOSPITAL BILLING PROCESS: UNDERSTANDING THE BASICS
- HIPAA–HOSPITAL CONNECTION
- BILLING COMPLIANCE
- CAREER OPPORTUNITIES IN HOSPITAL BILLING
- SUMMARY CHECKPOINTS
- CHAPTER REVIEW QUESTIONS
- WEBSITES TO EXPLORE
- Appendix A
- Appendix B
- Appendix C
- Glossary
- Index
- No. of pages: 504
- Language: English
- Edition: 8
- Published: September 14, 2023
- Imprint: Elsevier
- Paperback ISBN: 9780323884006
- eBook ISBN: 9780323934107
JP
Julie Pepper
Julie Pepper has spent her entire career in health care as a medical assistant in a variety of offices and clinics, developing expertise in the electronic health record and as an instructor in a medical assistant program. She combines her education in dietetics with her clinical and administrative experience as an instructor in the Medical Assisting program at Chippewa Valley Technical College in Wisconsin, where she taught for 21 years and from where she retired from teaching. Julie was also the program director for the college’s Health Navigator program. She has served as a reviewer and contributor to numerous Medical Assisting educational products over the last decade, including Sim Chart for the Medical Office. She currently serves as the sole author of The Electronic Health Record for the Physician’s Office and The Simulated Administrative Medical Office. She has been leading author of Beik's Health Insurance Today text and workbook since the 8th edition. She also has been a coauthor for Kinn’s Medical Assisting Fundamentals, Kinn’s The Medical Assistant, and Today’s Medical Assistant. Julie strives to bring the needed information to students in a way to keep them interested in learning all that they need to be wonderful employees working in healthcare.
Affiliations and expertise
Professor Emeritus, Medical Assistant Program, Chippewa Valley Technical College, Eau Claire, Wisconsin