Health Insurance Today, A Practical Approach, 4th Edition

Health Insurance Today

4th Edition A Practical Approach

By Janet I. Beik, AA, BA, MEd, Southeastern Community College (retired), Administrative Instructor, Medical Assistant Program, West Burlington, IA, USA


Unit 1: Building a Foundation

  1. The Origins of Health Insurance
  2. Tools of the Trade: A Career as a Health (Medical) Insurance Professional
  3. The Legal and Ethical Side of Health Insurance
  4. Types and Sources of Health Insurance
  5. Unit 2: Health Insurance Basics

  6. Claim Submission Methods
  7. Traditional Fee-for-Service/Private Plans
  8. Unraveling the Mysteries of Managed Care
  9. Understanding Medicaid
  10. Conquering Medicare?s Challenges
  11. Military Carriers
  12. Miscellaneous Carriers: Workers? Compensation and Disability Insurance
  13. Unit 3: Cracking the Codes

  14. Diagnostic Coding
  15. Procedural, E&M, and HCPCS Coding
  16. Unit 4: The Claims Process

  17. The Patient
  18. The Claim
  19. Unit 5: Advanced Application

  20. The Role of Computers in Health Insurance
  21. Reimbursement Procedures: Getting Paid
  22. Hospital Billing and the UB-04

Appendixes

Appendix A: Sample Blank CMS-1500 (08/05)

Appendix B: CMS-1500 Claim Form and Completion Instructions

Appendix C: UB-40 Claim Form and Completion Instructions

Glossary