The Guide to Medical Billing and Coding

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ISBN: 9780131718494 | 0131718495
Cover: Paperback
Copyright: 1/1/2007

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Ideal for two-year and career college program in medical billing and coding. Practical Guide to what students need to succeed in the job including professionalism, billing and coding skills, and general studies. Written with one goal - to ensure students succeed the first and every day as a medical biller. It is ideal for learning how to perform as a medical biller/coder.

Introduction

(18)

The Historical Perspective

(1)

Job Roles and Duties

(1)

The Medical Team

(1)

Types of Healthcare Settings

(1)

Technology and the Medical Biller

(1)

Attitudes that Make a Successful Medical Biller

(2)

Workplace Professionalism

(1)

Interpersonal Skills

(1)

Professional Appearance

(1)

Stress

(1)

Pre-Vacation Work Planning

(1)

Detail Orientation

(1)

Certification Programs for Medical Billers

(1)

Summary

(1)

Assignments

(1)

Questions for Review

(1)

Exercises 1 -- 1 through 1 -- 3

(1)

Honors Certification™

(4)

Time Management and Prioritizing

(9)

Prioritization

(2)

Pressure Projects

(1)

Time Management

(1)

Counting Time Backwards

(1)

Overlapping Projects

(1)

Summary

(1)

Assignments

(1)

Questions for Review

(2)

Exercises 2 -- 1 through 2 -- 2

(1)

Honors Certification™

(1)

Legal Issues

(14)

Privacy Guidelines

(3)

Fraud

(1)

HIPAA and Fraud and Abuse

(1)

Embezzlement

(1)

Disclaimers

(1)

Legal Damages

(1)

Medical Ethics

(1)

Subpoenas

(1)

Instances in Which the Patient Should Be Notified and the File Notated

(2)

Summary

(1)

Assignments

(1)

Questions for Review

(1)

Honors Certification™

(1)

Clinical Records Management

(12)

Medical Charts

(2)

Filing the Chart

(1)

Medical Documentation Rules

(1)

Signature Cards

(1)

Retention of Records

(1)

Storing Medical Records

(1)

Electronic Medical Charting

(1)

Computerized Files

(1)

Record Transfers

(1)

Summary

(1)

Assignments

(1)

Questions for Review

(1)

Honors Certification™

(1)

Medical Documentation Forms

(11)

Patient Information Sheet

(1)

Release of Information Form

(1)

Assignment of Benefits Form

(5)

Patient History Form

(1)

Insurance Verification

(1)

Additional Suggestions

(2)

Summary

(1)

Assignments

(1)

Questions for Review

(1)

Exercise 5 -- 1

(1)

Honors Certification™

(1)

Contract Interpretation

(25)

Blue Cross/ Blue Shield

(1)

Contract Provisions

(2)

Contract Benefits

(5)

Exclusions

(1)

Allowed Amounts

(1)

Pre-Certification of Inpatient Admissions

(1)

Utilization Review

(1)

Second Surgical Opinion Consultations

(1)

Summary

(1)

Assignments

(1)

Questions for Review

(1)

Exercises 6 -- 1 through 6 -- 5

(5)

Honors Certification™

(1)

Sample Insurance Contract

(6)

Medicare

(26)

Tefra/Defra

(1)

Medicare Eligibility

(1)

Providers of Service

(1)

The Two Parts of Medicare

(2)

Approved or Reasonable Charges

(1)

Billing Medicare Services

(4)

Assignment of Benefits

(2)

Coordinating Medicare w/Other Insurance

100

(1)

Estimating Medicare Coverage

100

(1)

Diagnosis-Related Group Billing

101

(1)

Medicare Denials

101

(1)

Medicare Advance Notice

102

(1)

The Medicare Appeals Process

102

(4)

Medical Fraud and Abuse

106

(2)

Medicare Supplement

108

(1)

Medicare and Veterans

108

(1)

Medicare and Managed Care

109

(2)

Medicare Notice of Non-Coverage

111

(1)

Medicare Timeliness Reports

112

(2)

Summary

114

(1)

Assignments

114

(1)

Questions for Review

114

(1)

Exercise 7 -- 1

115

(1)

Honors Certification™

115

(1)

Medicaid

116

(7)

Medicaid Billing Procedures

117

(1)

Treatment Authorization Request

118

(2)

Reimbursement from Medicaid

120

(1)

Summary

121

(1)

Assignments

122

(1)

Questions for Review

122

(1)

Honors Certification™

122

(1)

Workers' Compensation

123

(18)

Employee Activities

124

(1)

Time Limits

125

(1)

Types of Claims

125

(2)

Benefits of Workers' Compensation

127

(1)

Workers' Compensation Reform

127

(1)

Medical Service Order

128

(1)

Patient Records

129

(1)

Doctor's First Report

129

(2)

Subsequent Progress Reports

131

(1)

Physician's Final Report

131

(1)

Delay of Adjudication

132

(1)

Billing for Workers' Compensation

132

(1)

Delinquent Claims

133

(1)

Fraud and Abuse

133

(2)

Third Party Liability

135

(1)

Liens

135

(1)

Reversals

136

(1)

Summary

136

(1)

Assignments

136

(3)

Questions for Review

139

(1)

Exercise 9-1

140

(1)

Honors Certification™

140

(1)

Managed Care

141

(34)

Rising Health Care Costs

142

(1)

Decreasing Costs

143

(1)

Managed Care

144

(2)

HMO Coverage

146

(1)

Preferred Provider Organizations

147

(1)

Billing Managed Care

148

(3)

Groups/IPAs

151

(1)

Capitation Payments

152

(3)

Patient Charts

155

(1)

HMO Appointment Scheduling

156

(2)

Authorizations, Referrals, and Second Opinions

158

(1)

Denial of Service to Members

159

(2)

Member Grievances and Complaints

161

(1)

Transfers

162

(1)

Disenrollment

162

(1)

Continuing Care

163

(1)

Miscellaneous Services

164

(1)

Facility Requirements

165

(1)

Sanctions

166

(1)

Claim Payments

167

(6)

Summary

173

(1)

Assignments

173

(1)

Questions for Review

174

(1)

Honors Certification™

174

(1)

Miscellaneous Billing Procedures

175

(14)

Billing for Service

176

(1)

Determining the Proper Billing Amount

177

(1)

Billing Forms

177

(2)

Additional Suggestions

179

(1)

Billing Tips/Issues

179

(1)

Special Services

180

(1)

Maximum Reimbursement Tips

180

(1)

Collecting the Patient Portion

181

(1)

Patient Claim form

182

(1)

Coordination of Benefits

182

(4)

COB With Health Maintenance Organizations

186

(1)

Tricare

186

(1)

Summary

187

(1)

Assignments

187

(1)

Questions for Review

187

(1)

Exercise 11 -- 1

188

(1)

Honors Certification™

188

(1)

Patient Accounting

189

(14)

Accounts Payable/ Receivable

190

(1)

The Ledger Card

190

(2)

Insurance Payments

192

(1)

Posting Payments

193

(1)

Balance Billing

193

(1)

Follow-Ups

194

(2)

Collections

196

(1)

Collections Procedures

197

(3)

Small Claims Court

200

(1)

Summary

200

(1)

Assignments

200

(1)

Questions for Review

201

(1)

Exercise 12 -- 1

202

(1)

Honors Certification™

202

(1)

Office Accounting

203

(6)

Petty Cash

203

(2)

Office Reports

205

(2)

Summary

207

(1)

Assignments

207

(1)

Questions for Review

207

(1)

Honors Certification™

208

(1)

Terminology

209

(13)

Insurance Terminology

209

(4)

Provider Abbreviations

213

(1)

Medical Abbreviations

214

(3)

Medical Symbols

217

(1)

Summary

217

(1)

Assignments

217

(1)

Questions for Review

218

(1)

Exercises 14 -- 1 through 14 -- 4

218

(3)

Honors Certification™

221

(1)

Reference Books

222

(9)

ICD-9

222

(1)

CPT®/RVS

223

(1)

HCPCS

223

(1)

Physicians' Desk Reference

223

(1)

Medical Dictionary

223

(2)

Merck Manual

225

(1)

Summary

225

(1)

Assignments

225

(1)

Questions for Review

226

(1)

Exercises 15 -- 1 through 15 -- 4

227

(3)

Honors Certification™

230

(1)

ICD-9

231

(19)

History of the ICD-9

231

(1)

Contents of the ICD-9

232

(1)

How to Use the ICD-9

233

(1)

General Guidelines

233

(2)

Main Terms

235

(1)

Exceptions

236

(2)

V Codes

238

(1)

E Codes

239

(1)

Signs and Symbols Used in the ICD-D

239

(1)

Billing Tips

240

(1)

ICD-10

241

(1)

Summary

242

(1)

Assignments

242

(1)

Questions for Review

243

(1)

Exercises 16 -- 1 through 16 -- 5

244

(5)

Honors Certification™

249

(1)

CPT® Coding

250

(26)

Using the CPT®

251

(1)

Semicolons in the CPT®

251

(1)

Signs and Symbols Used in the CPT®

252

(1)

Using the CPT® Index

252

(1)

Modifiers

252

(1)

Unlisted Codes

252

(1)

Evaluation and Management Codes

253

(2)

Anesthesia

255

(1)

Surgery

256

(4)

Radiology/X-ray

260

(1)

Pathology/Laboratory

260

(2)

Medicine

262

(3)

Billing Tips

265

(1)

Summary

265

(1)

Assignments

265

(1)

Questions for Review

265

(1)

Exercises 17 -- 1 through 17 -- 10

266

(9)

Honors Certification™

275

(1)

HCPCS Coding

276

(16)

General Information

277

(1)

Coding Using the HCPCS Manual

278

(1)

Sections of the HCPCS Manual

278

(1)

Transportation Services

278

(2)

Medical and Surgical Supplies

280

(1)

Miscellaneous and Experimental

280

(1)

Enteral and Parenteral Therapy

280

(1)

Temporary Hospital Outpatient PPS

281

(1)

Dental Procedures

281

(1)

Durable Medical Equipment

282

(2)

Procedures and Professional Services

284

(1)

Rehabilitative Services

284

(1)

Drugs Administered Other than Oral Method

284

(1)

Immunosuppressive Drugs

285

(1)

Chemotherapy Drugs

285

(1)

Temporary Codes for DMERCs

285

(1)

Orthotic Procedures

285

(1)

Prosthetic Procedures

286

(1)

Medical Services

286

(1)

Pathology/Laboratory

286

(1)

Temporary Codes

286

(1)

Diagnostic Radiology Services

286

(1)

Private Payer Codes

286

(1)

State Medicaid Agency Codes

287

(1)

Vision Services

287

(1)

Hearing Services

287

(1)

Modifiers

287

(1)

Summary

287

(1)

Assignments

287

(1)

Questions for Review

288

(1)

Exercises 18 -- 1 through 18 -- 2

289

(2)

Honors Certification™

291

(1)

Medications and the PDR

292

(6)

Generic vs. Brand Name Drugs

292

(1)

Service Plans

293

(1)

Physicians' Desk Reference

293

(1)

Definitions

294

(1)

Symbols

294

(1)

Summary

294

(1)

Assignments

295

(1)

Questions for Review

295

(1)

Exercises 19 -- 1 through 19 -- 3

296

(1)

Honors Certification™

297

(1)

CMS-1500

298

(10)

Item # and Item Name/Description

298

(5)

Item 24B, Place of Service

303

(2)

Tips on Completing the CMS-1500

305

(1)

Summary

305

(1)

Assignments

305

(1)

Questions for Review

306

(1)

Exercise 20 -- 1

307

(1)

Honors Certification™

307

(1)

UB-92 Hospital Billing Form

308

(29)

Item# and Item Name/Description

308

(5)

Item 4, Type of Bill

313

(1)

Item 19, Type of Admission

314

(1)

Item 20, Source of Admission

314

(1)

Item 22, Patient Status

315

(1)

Items 24-30, Condition Codes

315

(3)

Items 32-35, Occurrence Codes

318

(3)

Item 33, Occurrence Span Codes and Dates

321

(1)

Items 39-41, Value Codes and Amounts

322

(2)

Item 42, Hospital Revenue Codes

324

(1)

Item 53, Assignment of Benefits

324

(1)

Item 59, Relationship

325

(1)

Item 64, Employment Status Code

325

(1)

Summary

325

(1)

Assignments

325

(1)

Questions for Review

326

(1)

Exercise 21 -- 1

327

(2)

Honors Certification™

329

(1)

Appendix 21 -- 1 Hospital Revenue Codes

330

(7)

Hospital Billing

337

(8)

Which Claim Form Is Right?

338

(2)

Charge Description Masters

340

(1)

Entering Charges

341

(1)

How Billing Affects Other Departments

342

(1)

Preauthorization, Pre-certifications and Utilization Reviews

342

(1)

Ambulatory Surgical Centers

343

(1)

Summary

343

(1)

Assignments

343

(1)

Questions for Review

344

(1)

Honors Certification™

344

(1)

Medical Reports

345

(34)

Abstracting From Medical Records

345

(1)

Triage Reports

345

(1)

Operative Reports

346

(1)

Diagnostic Testing Reports

346

(1)

Medical History and Physical Examination Reports

346

(1)

Summary

346

(1)

Assignments

346

(1)

Questions for Review

347

(1)

Exercises 23 -- 1 through 23 -- 20

348

(26)

Appendix 23 -- 1

374

(4)

Honors Certification™

378

(1)

Claims Submission Process

379

(9)

Clean Claims

380

(1)

Incomplete Data Master List

380

(1)

Submission Time Limits

381

(1)

Optical Scanning Guidelines

381

(1)

Submitting the Claims

382

(1)

Electronic Claims Submission

382

(1)

Billing Reports

383

(1)

Tracer Claims/Delinquent Claims

383

(1)

Denied Claims

384

(1)

Re-submissions

384

(1)

Adjusted Claims

384

(1)

Appeals

385

(1)

Balance Billing Patients for Downcoded or Denied Claims

385

(1)

State Insurance Commissioner

385

(1)

Summary

385

(1)

Assignments

386

(1)

Questions for Review

386

(1)

Honors Certification™

387

(1)

Calculator Basics

388

(7)

Key Descriptions

388

(1)

Printer Tape Symbols

389

(1)

Summary

390

(1)

Assignments

390

(1)

Questions for Review

390

(1)

Exercises 25 -- 1 through 25 -- 4

391

(3)

Honors Certification™

394

(1)

General Office Procedures

395

(9)

Mail

395

(3)

Ordering Supplies

398

(2)

Office Machines

400

(1)

Tickler Files

401

(1)

Summary

402

(1)

Assignments

402

(1)

Questions for Review

402

(1)

Honors Certification™

403

(1)

Customer Service/Patient Relations

404

(22)

Understanding Needs

405

(1)

Attitudes and Feelings

405

(1)

First Impressions and Image

406

(1)

Characteristics of Client Relations

406

(1)

Customer Service Job Functions

406

(1)

The Art of Listening

407

(3)

Handling Difficult Clients

410

(2)

Handling Unwanted Callers

412

(1)

Professionalism

413

(1)

Telephone Techniques

414

(1)

Phone Calls

415

(1)

Telephone Etiquette

416

(1)

Maintaining an Appointment Calendar

417

(2)

Summary

419

(1)

Assignments

419

(1)

Questions for Review

420

(1)

Exercises 27 -- 1 through 27 -- 7

420

(5)

Honors Certification™

425

(1)

Computer Basics

426

(10)

The Computer

427

(1)

The Monitor

427

(1)

The Keyboard

428

(2)

Frustration Free Computing

430

(2)

Computer Terms

432

(2)

Summary

434

(1)

Assignments

434

(1)

Questions for Review

435

(1)

Honors Certification™

435

(1)

Correspondence for the Medical Office

436

(13)

The Opening

437

(1)

The Body

437

(1)

The Closing

438

(1)

Correspondence Containing Negative Content

438

(1)

Format of the Letter

438

(5)

Memos

443

(2)

Postal Abbreviations

445

(1)

Summary

446

(1)

Assignments

446

(1)

Questions for Review

446

(1)

Exercises 29 -- 1 through 29 -- 2

447

(1)

Honors Certification™

448

(1)

Job Search Preparation

449

Job Search Objectives

449

(1)

Uniqueness

449

(1)

Target Audience

450

(1)

Build Your Database

450

(1)

The Resume

450

(3)

The Cover Letter

453

(1)

Marketing Yourself

453

(1)

The Job Interview

453

(3)

Getting Paid What You Are Worth

456

(1)

Summary

457

(1)

Assignments

457

(1)

Questions for Review

458

(1)

Exercise 30 -- 1

458

(1)

Resume Questionnaire

459

(2)

Honors Certification™

461

(1)

Sample Resume # 1

462

(1)

Sample Cover Letter # 1

463

(1)

Sample Resume # 2

464

(1)

Sample Resume # 3

465

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The Guide to Medical Billing and Coding

Summary

Table of Contents

Supplemental Materials