Guide to Advanced Medical Billing A Reimbursement Approach

Advanced Medical Billing and Coding: A Reimbursement Approach offers an innovative look at the complete billing, coding and medical claims reimbursement process. Its unique dual perspective considers the roles of the medical billing and coding professional and the health claims examiner. An extensive revision, this edition includes the new ICD-10 code set, the most current billing forms, and coverage of the most recent healthcare legislations. Four new chapters focus on processing medical claims for Non-Medicare, Medicare and Workers' Compensation. With its balanced perspective, students learn the perspectives of both the medical office and insurance company which prepares them for the complete billing, coding, and reimbursement cycle.

SECTION I: INTRODUCTION TO ISSUES RELATED TO HEALTH CLAIMS PROCESSING

1.      Introduction to Technical and Legal Issues

2.      Resource Manuals and Billing Forms

SECTION II: CONTRACT INTERPRETATION AND ADMINISTRATION

3.      Medical Plan Provisions

4.      Medical Benefit

SECTION III: MEDICAL CLAIMS EXAMINING GUIDELINES AND PROCEDURES

5.      Medical Claims Administration

6.      Physician's, Clinical, and Hospital Services Claims

7.      Surgery and Anesthesia Claims

8.      Medicare and Medicaid

9.      Workers' Compensation

10.  Managed Care Claims

SECTION IV: MANAGEMENT OF CLAIMS EXAMINING

11.  Claims Examination

12.  Processing Non-Medicare Claims

13.  Processing Medicare Claims

14.  Processing Workers' Compensation Claims

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