Health Insurance Today
- 7th Edition - September 10, 2020
- Authors: Janet I. Beik, Julie Pepper
- Language: English
- Paperback ISBN:9 7 8 - 0 - 3 2 3 - 6 5 5 5 3 - 8
- eBook ISBN:9 7 8 - 0 - 3 2 3 - 6 5 5 5 4 - 5
Master the complexities of health insurance with this easy-to-understand guide! Health Insurance Today: A Practical Approach, 7th Edition provides a solid foundation in basics su… Read more
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Request a sales quoteMaster the complexities of health insurance with this easy-to-understand guide! Health Insurance Today: A Practical Approach, 7th 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 website. This edition adds coverage of the latest advances and issues in health insurance, including EHRs, Medicare, and other types of carriers. Written by Medical Assisting educators Janet Beik and Julie Pepper, this resource prepares you for a successful career as a health insurance professional.
- What Did You Learn? review questions, Imagine This! scenarios, and Stop and Think exercises ensure that you understand the material, can apply it to real-life situations, and develop critical thinking skills.
- Clear, attainable learning objectives highlight the most important information in each chapter.
- CMS-1500 software with case studies on the Evolve companion website provides hands-on practice with filling in a CMS-1500 form electronically.
- UNIQUE! UB-04 software with case studies on Evolve provides hands-on practice with filling in UB-04 forms electronically.
- UNIQUE! SimChart® for the Medical Office (SCMO) cases on Evolve give you real-world practice in an EHR environment.
- HIPAA Tips emphasize the importance of privacy and of following government rules and regulations.
- Direct, conversational writing style makes it easier to learn and remember the material.
- End-of-chapter summaries relate to the chapter-opening learning objectives, provide a thorough review of key content, and allow you to quickly find information for further review.
- Chapter review questions on Evolve help you assess your comprehension of key concepts
- Cover image
- Title page
- Table of Contents
- Copyright
- Reviewers
- Preface
- A word about HIPAA
- About the authors
- Acknowledgments
- List of Tables
- List of Illustrations
- UNIT I. Building a Foundation
- 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
- 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 and Ethics Applicable to Health Insurance
- Important Legislation Affecting Health Insurance
- Medical Ethics and Medical Etiquette
- Medical Health Record
- Documentation and Maintenance of Patient Medical 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 Methods
- Billing Services
- Collection Agencies
- Small Claims Litigation
- Summary Checkpoints
- Chapter Review Questions
- Websites to Explore
- UNIT II. Health Insurance Basics
- 6. 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
- 7. 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
- 8. Reimbursement models
- Fee-for-Service/Indemnity Insurance
- Managed Care Insurance
- Minimum Essential Coverage and the Marketplace
- Standard Costs Associated With Insurance Plans
- How Medical Fees Are Determined
- The Changing Structure of Healthcare in the United States
- Healthcare Reform and Preexisting Conditions
- HIPAA and Healthcare Reform
- Commercial or Private Health Insurance
- Largest Commercial Insurance Companies
- Coverage When Traveling Abroad
- Participating Versus Nonparticipating Providers
- Submitting Commercial Claims
- Commercial Claims Involving Secondary Coverage
- Summary Checkpoints
- Chapter Review
- Websites to Explore
- 9. The changing face of 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 the Affordable Care Act
- Managed Care Accreditation and Regulation
- Claims Management
- HIPAA and Managed Care
- Impact of Managed Care
- Future of Managed Care
- Summary Checkpoints
- Chapter Review Questions
- Websites to Explore
- 10. 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
- 11. Conquering Medicare’s challenges
- 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
- 12. Military carriers
- Military Health Programs
- TRICARE
- TRICARE’s Additional Coverage Options
- Verifying TRICARE Eligibility
- TRICARE Provider Types
- TRICARE Beneficiary Cost-Sharing
- TRICARE Claims Processing
- CHAMPVA
- CHAMPVA Program Options and Benefits
- Filing CHAMPVA Claims
- Military Carriers and HIPAA
- Summary Checkpoints
- Chapter Review Questions
- Websites to Explore
- 13. Miscellaneous carriers
- Workers’ Compensation
- Private and Employer-Sponsored Disability Income Insurance
- Federal Disability Programs
- Summary Checkpoints
- Chapter Review Question
- Websites to Explore
- UNIT III. Cracking The Codes
- 14. 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
- Coding Steps for the Alphabetic Index
- Tabular List
- 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
- 15. 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
- UNIT IV. Advanced Application
- 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 Medical Record
- Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
- What Is Interoperability in Healthcare?
- 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
- Peer Review 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
- 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: Sample blank CMS 1500 (02/12)
- Appendix B: CMS 1500 claim forms and completion instructions
- Appendix C: UB 04 claim forms and completion instructions
- Glossary
- Resources
- Index
- No. of pages: 520
- Language: English
- Edition: 7
- Published: September 10, 2020
- Imprint: Saunders
- Paperback ISBN: 9780323655538
- eBook ISBN: 9780323655545
JB
Janet I. Beik
Janet Beik has degrees in business and higher education. Janet was an instructor in the Medical Assistant Program at Southeastern Community College, in West Burlington, Iowa, for several years. She authored the first edition of her book, Health Insurance Today in 2003, and the 7th edition has just published.
Affiliations and expertise
Southeastern Community College (retired), Administrative Instructor, Medical Assistant Program, West Burlington, IowaJP
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