Nelson Higher Education

Higher Education

A Guide to Health Insurance Billing, 4th Edition

  • includes Premium Website, 2 term (12 months) Printed Access Card
  • Marie A. Moisio, MA, RHIA
  • ISBN-10: 1285193598
  • ISBN-13: 9781285193595
  • 640 Pages | Paperback
  • Previous Editions: 2011, 2006, 2001
  • COPYRIGHT: 2014 Published
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About the Product

Prepare your students for career success with this trusted introduction to the world of health insurance billing and the dynamic, growing field of health information management. A GUIDE TO HEALTH INSURANCE BILLING, Fourth Edition, provides a thorough, practical overview of key principles and current practices, from patient registration to claims submission. Now updated to reflect the latest trends, technology, terminology, legal and regulatory guidelines, and coding systems—including ICD-10—the new edition also features a dynamic full-color layout designed to engage today's students. The text includes abundant exercises, examples, case studies, and activities focused on real-world applications, including step-by-step procedures for generating, processing, and submitting health insurance claims to commercial, private, and government insurance programs. An access code for SimClaim interactive online billing software is also provided; this program puts students' skills to the test with case studies that require form completion.


  • Appendix C provides a helpful Abbreviations list.

  • This trusted text provides excellent preparation for students pursuing certification by The American Health Information Management Association (AHIMA), American Medical Billing Association (AMBA), or American Academy of Professional Coders (AAPC).

  • The author provides detailed, step-by-step guidelines to help students complete common paperwork, such the CMS-1500 and UB-04 billing forms, while SimClaim student practice software available with the text offers additional interactive practice with the CMS-1500 form.

  • Abundant examples, case studies, hands-on exercises, and critical thinking activities help students master and apply key concepts and techniques, including generating, processing, and submitting health insurance claims to commercial, private, and government insurance programs.

  • Useful instructor resources available with the text—including more than 300 lecture slides, a test bank with more than 1,000 questions, and a digital Instructor's Manual—make class preparation, student evaluation, and course management easier and more efficient.

  • Every chapter includes an overview of key topics and learning objectives, abundant illustrations and examples, and a concluding summary and review section, making it easier for students to absorb the material and prepare for success in class and their future careers.

About the Author

Marie A. Moisio, MA, RHIA

Marie A. Moisio, M.A., RHIA, has 25 years of experience in health information management. In addition to teaching medical billing, medical coding and health information processing for more than 15 years, she served as director of health information departments in a 400-bed regional medical center and a 450-bed regional psychiatric treatment facility. Her professional experience also includes service as a consultant for several long-term care facilities and physician offices as well as positions in health information management, compliance, coding practices, insurance claim auditing and patient record documentation. Moisio has taught numerous workshops covering legal aspects of health information management and documentation. She is also the author of A GUIDE TO HEALTH INSURANCE BILLING and UNDERSTANDING LABORATORY & DIAGNOSTIC TESTS.

Table of Contents

1. The Insurance Billing Specialist.
2. Legal Aspects of Insurance Billing.
3. Introduction to Health Insurance.
4. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM/PCS).
5. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).
6. Current Procedural Terminology (CPT) and Healthcare Common Procedure.
7. Developing An Insurance Claim.
8. Common CMS-1500 Completion Guidelines: Private/Commercial Insurance.
9. Electronic Claims Submission.
10. UP-04 (CMS-1450) Completion Guidelines.
11. Blue Cross/Blue Shield.
12. Medicare.
13. Medicaid.
15. Workers Compensation.
Appendix A: Superiorland Clinic Practice Manual.
Appendix B: Assignments: Case Study 2-1 Through Case Study 2-10.
Appendix C: Abbreviations.

New to this edition

  • The Fourth Edition includes new and updated information related to important industry trends, technology, terminology, and legal and regulatory guidelines, giving students a current introduction to this dynamic, continually evolving field.
  • The text includes extensive, up-to-date coverage of the ICD-10-CM and ICD-10-PCS, as well as a review of ICD-9, providing students with a solid background in both current and historic coding conventions.
  • Answers keys for coding exercises cover both ICD-9 and ICD-10, allowing for easy customization based on your particular course, organization, or students' interests.
  • New and expanded coverage in the current edition includes a stronger emphasis on electronic claims processing, updated information related to the Affordable Health Care Act, and current Medicare care guidelines.


All supplements have been updated in coordination with the Main title.
Please see Main title page for new to this edition information.

Instructor Supplements

Instructor's Manual  (ISBN-10: 1285193601 | ISBN-13: 9781285193601)

The instructor's Manual serves as an instructional resource and provides teaching tips or guidelines, essay questions, answers to review and test questions, key objectives, glossary, appendices and exercises for content reinforcement.

Instructor's Resource CD-ROM  (ISBN-10: 128519361X | ISBN-13: 9781285193618)

The Instructor Resources includes PowerPoint® presentations for each core textbook chapter, computerized test bank, and the Instructor's Manual.

Premium Website 2 terms Instant Access Code  (ISBN-10: 1285193563 | ISBN-13: 9781285193564)

Attention Premium Website user: Cengage support for existing users of Premium Websites will end of 8/1.

Student Supplements

Premium Website 2 terms Instant Access Code  (ISBN-10: 1285193563 | ISBN-13: 9781285193564)

Attention Premium Website user: Cengage support for existing users of Premium Websites will end of 8/1.