Susan Magovern,
Chestnut Hill Enterprises Jean Jurek,
Erie Community College City Campus-Buffalo
ISBN: 0073520896 Copyright year: 2009
Revision Changes
NEW section on HIPAA in Chapter 1: Of special importance is the expanded coverage of HIPAA in Chapter 1. Professionals in the health care industry must understand current regulations. The most important is compliance with HIPAA rules concerning medical insurance and billing, because the law now provides for civil and criminal penalties when fraud or abuse is found, and billers are potentially liable along with their employers. In today’s health care environment, claims cannot be simply correct. Claims, as well as the process used to create them, must also comply with the rules imposed by federal and state law and by government and private payer health care program requirements. HIPAA Tip feature boxes are included in each chapter, in addition to the necessary chapter content.
NEW approach to the hospital billing process in Chapter 2: The established ten-step medical billing process that is used in other McGraw-Hill textbooks, such as Valerius et al: Medical Insurance 3e, Newby: From Patient to Payment 5/e, and Sanderson: Computers in the Medical Office 5/e, has been followed by defining it for the hospital environment. An illustration of this process is printed on the inside front cover of the text/workbook for easy reference. The illustration captures the ten-step billing cycle that is used to organize the text presentation in Chapter 2.
NEW chapters for hospital coding and payment methods: The previous Chapter 4 on coding and payment has been replaced with two separate chapters—Chapter 4, "Medical Coding Basics," and Chapter 5, "Payment Methods and Billing Compliance." Patient account specialists must understand basic medical coding guidelines and principles in order to verify diagnosis and procedure codes that are used on charge slips and health care claims. For this reason, Chapter 4 in the new edition expands coverage of the fundamental principles of diagnostic and procedural coding in the hospital setting. Chapter 5 presents more detailed coverage of the inpatient and outpatient payment systems used by Medicare, together with the latest updates to each. A new section on billing compliance defines fraud and abuse and discusses the importance of compliance plans in today's regulatory environment.
NEW form-completion information for the newly mandated UB-04 claim: The UB-92 claim form used in hospital billing was replaced by its successor, the UB-04, on March 1, 2007. The second edition of Hospital Billing has been fully revised to provide accurate and up-to-date information on UB-04 claim completion. Information on the UB-04’s new format, fields, data elements, and billing requirements is provided in ten chapters that cover every section of the form. The information applies to claim preparation whether it is reported in electronic format or as a paper claim. The UB-04, like its predecessor the UB-92, represents a complex set of decisions. The text/workbook is designed to provide students with background information on the form so that they will understand the context in which it is prepared and have the knowledge to comprehend the decisions needed to complete it.
NEW UB-04 form-completion method for the computer-based exercises and application materials: The second edition comes with a simulated UB-04 form that was created by McGraw-Hill for use with the text/workbook. The simulated form, which is designed to view, create, edit, and print UB-04 claims, is a pdf file that works with Adobe Reader. In Part 2 of the text/workbook, students analyze sample claims created with the form that apply information about each section of the form. In Part 3, students have the option to use the simulated form to complete the required inpatient and outpatient claims presented in the case studies.
UPDATED Appendix A: The tables in Appendix A have been updated to reflect the new UB-04 claim form. The tables include listings of the following UB-04 codes: type of bill codes, occurrence codes, value codes, and revenue codes.
NEW Appendix B: Appendix B, available at the text's Online Learning Center, contains two new tables. Table B-1: The Eighty-One UB-04 Form Locators, lists each field contained on the UB-04 form with a description of what the field contains and whether it is required by Medicare. Table B-2: A Comparison of the UB-92 and UB-04 Claim Forms, compares the old and new claims in terms of new data, deleted data, data with an expanded field size, and so on. Anyone already familiar with the UB-92 form can study Appendix B for a quick and concise introduction to the new form.
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2009 McGraw-Hill Higher Education