Workbook to Accompany Understanding Health

The restructured chapter content of the workbook offers application-based assignments with more critical thinking components. The assignments require learners to demonstrate an understanding of the content rather than simple recall of facts. Chapter 1 provides guidelines for professional development as well as initiating a job search, with numerous resources identified. Chapters 2-17 offer an in-depth review of health insurance billing and reimbursement concepts.

Introduction

vii

Health Insurance Specialist Career

1

(20)

Assignment 1.1 Interview of a Professional

1

(1)

Assignment 1.2 Ready, Set, Get a Job!

2

(14)

Assignment 1.3 Journal Abstract

16

(1)

Assignment 1.4 Professional Discussion Forums (Listservs)

17

(1)

Assignment 1.5 Multiple Choice Review

18

(3)

Introduction to Health Insurance

21

(12)

Assignment 2.1 Health Insurance Coverage Statistics

21

(4)

Assignment 2.2 Major Developments in Health Insurance (Research Paper)

25

(5)

Assignment 2.3 Multiple Choice Review

30

(3)

Managed Health Care

33

(6)

Assignment 3.1 National Committee for Quality Assurance (NCQA) Health Plan Report Card

33

(1)

Assignment 3.2 Managed Health Care Federal Legislation

34

(1)

Assignment 3.3 Multiple Choice Review

35

(4)

Life Cycle of an Insurance Claim

39

(14)

Assignment 4.1 Payment of Claims: Encounter Form

39

(2)

Assignment 4.2 Payment of Claims: Remittance Advice

41

(8)

Assignment 4.3 Payment of Claims: Explanation of Benefits

49

(1)

Assignment 4.4 Multiple Choice Review

50

(3)

Legal and Regulatory Issues

53

(8)

Assignment 5.1 HIPAA: Student Confidentiality Statement

53

(1)

Assignment 5.2 HIPAA: Preventing Health Care Fraud and Abuse

54

(2)

Assignment 5.3 HIPAA: Privacy and Security Rules

56

(1)

Assignment 5.4 Multiple Choice Review

56

(5)

ICD-9-CM Coding

61

(12)

Assignment 6.1 ICD-9-CM Index to Diseases

61

(1)

Assignment 6.2 Basic Coding

62

(1)

Assignment 6.3 Multiple Coding

62

(1)

Assignment 6.4 Combination Coding

63

(1)

Assignment 6.5 Coding Hypertension

63

(1)

Assignment 6.6 Coding Neoplasms

64

(1)

Assignment 6.7 Assigning V Codes (Factors Influencing Health Status and Contact with Health Services)

64

(1)

Assignment 6.8 Coding Burns, Fractures, and Late Effects

65

(1)

Assignment 6.9 Assigning E Codes (External Causes of Injury and Poisoning)

66

(1)

Assignment 6.10 Coding Procedures

66

(1)

Assignment 6.11 Coding Patient Cases

67

(2)

Assignment 6.12 Multiple Choice Review

69

(4)

CPT Coding

73

(12)

Assignment 7.1 CPT Index

73

(1)

Assignment 7.2 Evaluation and Management (E/M) Coding

74

(1)

Assignment 7.3 Anesthesia Coding

74

(1)

Assignment 7.4 Surgery Coding

75

(2)

Assignment 7.5 Radiology Coding

77

(1)

Assignment 7.6 Pathology and Laboratory Coding

77

(1)

Assignment 7.7 Medicine Coding

78

(1)

Assignment 7.8 Assigning CPT Modifiers

78

(1)

Assignment 7.9 Coding Case Studies

79

(3)

Assignment 7.10 Multiple Choice Review

82

(3)

HCPCS Coding

85

(12)

Assignment 8.1 HCPCS Index

85

(1)

Assignment 8.2 HCPCS Coding

86

(5)

Assignment 8.3 Coding Drugs in HCPCS

91

(1)

Assignment 8.4 HCPCS Level II National Modifiers

91

(1)

Assignment 8.5 Coding Case Studies

92

(2)

Assignment 8.6 Multiple Choice Review

94

(3)

CMS Reimbursement Methodologies

97

(8)

Assignment 9.1 Outpatient Prospective Payment System (OPPS)

97

(1)

Assignment 9.2 Diagnosis Related Groups

98

(3)

Assignment 9.3 Multiple Choice Review

101

(4)

Coding for Medical Necessity

105

(12)

Assignment 10.1 Choosing the First-Listed Diagnosis

105

(1)

Assignment 10.2 Linking Diagnoses with Procedures/Services

106

(1)

Assignment 10.3 National Coverage Determinations

106

(1)

Assignment 10.4 Coding from Case Scenarios

107

(1)

Assignment 10.5 Coding from SOAP Notes and Operative Reports

108

(4)

Assignment 10.6 Multiple Choice Review

112

(5)

Essential CMS-1500 Claim Instructions

117

(8)

Assignment 11.1 Optical Scanning Guidelines

117

(1)

Assignment 11.2 Entering Diagnoses and Procedures on the CMS-1500 Claim Form

117

(4)

Assignment 11.3 Multiple Choice Review

121

(4)

Commercial Insurance

125

(14)

Assignment 12.1 Commercial Primary CMS-1500 Claims Completion

125

(1)

Assignment 12.2 Commercial Secondary CMS-1500 Claims Completion

125

(6)

Assignment 12.3 Multiple Choice Review

131

(8)

Blue Cross and Blue Shield Plans

139

(12)

Assignment 13.1 BCBS Primary CMS-1500 Claims Completion

139

(1)

Assignment 13.2 BCBS Secondary CMS-1500 Claims Completion

139

(9)

Assignment 13.3 Multiple Choice Review

148

(3)

Medicare

151

(18)

Assignment 14.1 Medicare Primary CMS-1500 Claims Completion

151

(1)

Assignment 14.2 Medicare as Secondary Payer CMS-1500 Claims Completion

151

(8)

Assignment 14.3 Medicare/Medigap CMS-1500 Claims Completion

159

(1)

Assignment 14.4 Medicare/Medicaid CMS-1500 Claims Completion

159

(1)

Assignment 14.5 Multiple Choice Review

159

(10)

Medicaid

169

(10)

Assignment 15.1 Medicaid Primary CMS-1500 Claims Completion

169

(1)

Assignment 15.2 Medicaid Mother/Baby CMS-1500 Claims Completion

169

(7)

Assignment 15.3 Multiple Choice Review

176

(3)

Tricare

179

(8)

Assignment 16.1 Tricare Primary CMS-1500 Claims Completion

179

(1)

Assignment 16.2 Multiple Choice Review

179

(8)

Workers' Compensation

187

(70)

Assignment 17.1 Workers' Compensation Primary CMS-1500 Claims Completion

187

(1)

Assignment 17.2 Multiple Choice Review

187

(70)

InstaClaim Trial Version CD-ROM

257

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Workbook to Accompany Understanding Health Insurance A Guide to Billing and Reimbursement

Summary

Table of Contents

Supplemental Materials