Part

 Coverage

1: Working with Medical Insurance and Billing

Covers Steps 1 through 3 of the medical billing cycle by introducing the major types of medical insurance, payers, and regulators, as well as the medical billing cycle. Also covers HIPAA/HITECH Privacy, Security, and Electronic Health Care Transactions/Code Sets/Breach Notification rules.

2: Claim Coding

Covers Steps 4 through 6 of the medical billing cycle while building skills in correct coding procedures, using coding references, and complying with proper linkage guidelines.

3: Claims

Covers Step 7 of the medical billing cycle by discussing the general procedures for calculating reimbursement, how to bill compliantly, and preparing and transmitting claims.

4: Claim Follow-Up and Payment Processing

Covers Steps 8 through 10 of the medical billing cycle by describing the major third-party private and government-sponsored payers’ procedures and regulations along with specific filing guidelines. Also explains how to handle payments from payers, follow up and appeal claims, and correctly bill and collect from patients. This part includes two case studies that provide exercises to reinforce knowledge of completing primary/secondary claims, processing payments from payers, and handling patients’ accounts. The case studies in Chapter 15 can be completed using Connect Plus for simulated exercises created from Medisoft Advanced Version 17. The case studies in Chapter 16 can be completed using the CMS-1500 form.

5: Hospital Services

Provides necessary background in hospital billing, coding, and payment methods.