Fordney's Medical Insurance and Billing
- 17th Edition - August 7, 2024
- Latest edition
- Authors: Linda M. Smith, Cheryl Fassett
- Language: English
Gain the skills you need to succeed in insurance coding and billing! Fordney’s Medical Insurance and Billing, 17th Editionhelps you master the insurance billing specialist’s rol… Read more
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helps you master the insurance billing specialist’s role and responsibilities in areas such as diagnostic coding, procedural coding, HCPCs coding, medical documentation, billing, and collection. Using clear explanations, this book covers all types of insurance coverage commonly encountered in hospitals, physicians’ offices, and clinics. Step-by-step guidelines lead you through the submission of electronic claims and paper claims, as well as the job search and professional advancement. Written by coding specialist and educator Linda M. Smith, this market-leading text is a complete guide to becoming an efficient insurance billing specialist.
- NEW HCPCs Coding chapter covers ambulance billing, supply billing, and certificates of medical necessity
- NEW! Content on professionalism includes customer service, conflict management, diversity awareness, leadership, and other competencies to help you become an effective, engaged, and highly functioning employee
- NEW! Additional content on medical decision making helps you select the appropriate evaluation and management codes under the current documentation guidelines
- NEW! Additional examples of CMS claims include those from Blue Shield and Automobile Insurance
- NEW! Updates to credentialing include those specific to Medicare, Medicaid, and Workers’ Compensation
- Coverage of medical documentation, diagnostic coding, and procedural coding provides you with the foundation and skills needed to work in a physician’s office as well as ambulatory and inpatient settings
- Coverage of the role and responsibilities of the insurance billing specialist emphasizes advanced job opportunities and certification
- Chapter on HIPAA compliance as well as Compliance Alerts highlight important HIPAA compliance issues and the latest regulations
- Step-by-step procedures detail common responsibilities of the insurance billing specialist and coder
- Key terms and abbreviations are defined and emphasized, reinforcing your understanding of new concepts and terminology
- Color-coded icons denote and clarify information, rules, and regulations for each type of payer
- Insights From The Field includes more interviews with experienced insurance billing specialists, providing a snapshot of their career paths and offering advice to the new student
- Scenario boxes help you apply concepts to real-world situations
- Quick Review sections summarize chapter content and also include review questions
- Student Software Challenge on the Evolve website allows you to practice filling out interactive CMS-1500 forms
1. Role of an Insurance Billing Specialist
2. Privacy, Security, and HIPAA
3. Compliance, Fraud, and Abuse
Unit 2 Introduction to Health Insurance
4. Basics of Health Insurance
5. The Blue Plans, Private Insurance, and Managed Care Plans
6. Medicare
7. Medicaid and Other State Programs
8. TRICARE and Veterans Health Care
9. Workers’ Compensation, Automobile, and Liability Insurance
10. Disability Income Insurance and Disability Benefit Programs
Unit 3 Documentation and Coding for Professional Services
11. Medical Documentation and the Electronic Health Record
12. ICD-10-CM Coding
13. CPT Coding
14. HCPCS Level II Coding
Unit 4 Claims Submission in the Medical Office
15. The Paper Claim CMS 1500
16. The Electronic Claim
Unit 5 Revenue Cycle Management
17. Receiving Payments and Insurance Problem-Solving
18. Collection Strategies
Unit 6 Health Care Facility Billing
19. Introduction to Health Care Facilities and Ambulatory Surgery Centers
20. Billing for Health Care Facilities
Unit 7 Employment
21. Seeking a Job and Attaining Professional Advancement
- Edition: 17
- Latest edition
- Published: August 7, 2024
- Language: English
LS
Linda M. Smith
CF
Cheryl Fassett
Cheryl Fassett has worked in healthcare administration, billing, and coding for 34 years. She was a coding/billing specialist and account manager with Practicare Medical Management for five years and has been the practice manager for Riverside Associates in Anesthesia for the last 29 years. Her job tasks are varied and include auditing the coding, billing, and reimbursement for the practice, as well as payroll, scheduling, human resources, and working with the accounting department, legal team, and pension manager. In addition to this she has earned certifications from the AAPC in coding, billing, auditing, practice management, risk adjustment coding, clinical documentation, and instructing the AAPC coding curriculum. She was a contributor and subject matter expert for the Fordney Smith Medical Insurance and Billing 15th , 16th, and 17th editions. She has created and presented workshops and training to AAPC members, billing companies, and hospital staff on topics ranging from HIPAA compliance, revenue cycle and anesthesia coding to leadership, communication, cognitive biases and limiting beliefs.