Nelson Higher Education

Higher Education

Understanding Health Insurance: A Guide to Billing and Reimbursement, 12th Edition

  • includes Premium Website, 2 terms (12 months) Printed Access Card and Cengage EncoderPro.com Demo Printed Access Card
  • Michelle Green
  • ISBN-10: 1285737520
  • ISBN-13: 9781285737522
  • 832 Pages | Paperback
  • Previous Editions: 2013, 2011, 2008
  • COPYRIGHT: 2015 Published
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Overview

About the Product

Understanding Health Insurance, 12th Edition, is the essential learning tool your students need when preparing for a career in medical insurance billing. This comprehensive and easy-to-understand text is fully-updated with the latest code sets and guidelines, and covers important topics in the field like managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. The twelfth edition has been updated to include new legislation that affects healthcare, ICD-10-CM coding, implementing the electronic health record, the Medical Integrity Program (MIP), medical review process, and more. The practice exercises in each chapter provide plenty of review, and the workbook (available separately) provides even more application-based assignments and additional case studies for reinforcement. Includes free online SimClaim™ CMS-1500 claims completion software, and free-trial access to Optum's EncoderPro.com—Expert encoder software.

Features

  • Alerts such as the HIPAA Alerts, Coding Tips, ICD-10, and Managed Care Alerts draw attention to critical areas of content and provide experience-based recommendations.

  • Notes appear throughout and clarify content, give references, provide background, or emphasize rule exceptions.

  • Study Checklist at the end of each chapter directs students to other learning aids to enhance understanding and build confidence.

  • Practical Claim Handling: In addition to ongoing, in-text references to claim forms and related on-the-job issues, UNDERSTANDING HEALTH INSURANCE, 12th Edition gives readers practice completing actual CMS-1500 claim forms by hand and online using easy-to-follow instructions.

  • Contemporary Coding: Exhaustive CPT and ICD-10 coverage outpaces competing health insurance texts with the latest coding manual information, numerous examples and skill-building exercises, and detailed explanations that prepare students for upcoming changes while building confidence with new requirements.

  • 59-day free trial of Encoder Pro.com—Expert™ from Optum lets students look up codes and descriptions quickly and with greater accuracy.

About the Author

Michelle Green

Michelle Green has been a SUNY Distinguished Teaching Professor in the health information technology department at Mohawk Valley Community College in Utica, New York, since 2017. Ms. Green held the position of SUNY Distinguished Teaching Professor in the physical and life sciences department at the State University of New York, College of Technology for more than 30 years. An active member of the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA), Ms. Green has been recognized both for her excellence in teaching and for her significant contributions to the health information management profession. She has earned numerous awards, including the State University of New York Chancellor’s Award for Excellence in Teaching, Alfred State College’s Alumni Association Teacher of the Year, Who’s Who Among America’s Teachers and AHIMA’s FORE Triumph Educator Award. Ms. Green is a registered health information administrator (RHIA), a fellow of the American Health Information Management Association (FAHIMA) and a certified procedural coder (CPC). She earned an M.P.S. degree from Alfred University and a B.S. from Daemen College. Ms. Green has authored three popular textbooks related to coding, revenue management and health information management.

Table of Contents

1. Health Insurance Specialist Career.
2. Introduction to Health Insurance.
3. Managed Healthcare.
4. Processing an Insurance Claim.
5. Legal and Regulatory Issues.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding for Medical Necessity.
11. Essential CMS-1500 Claim Instructions.
12. Commercial Insurance.
13. Blue Cross Blue Shield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers' Compensation.
Appendices.
Bibliography.
Glossary.
Index.

New to this edition

  • Expanded EMR: Added coverage of Electronic Medical Records includes more workbook problems for better context and clarity.
  • All-New Coding: Completely revised according to 2014's new ICD-10 code sets, UNDERSTANDING HEALTH INSURANCE, 12th Edition also presents the former ICD-9 codes as a legacy classification system.
  • Interactive Learning: The hands-on coding cases, games, and quizzing available in CourseMate and in our online resources help students understand concepts and master skills faster than book learning alone.
  • Revised Claim Forms: New CMS-1500 standardized forms appear throughout the text for practice with manual insurance claims, while the included SimClaim™ practice software trial familiarizes readers with the electronic version of this commonly used claim form.

Supplements

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

Instructor Supplements

Cengage Testing, powered by Cognero® Instant Access  (ISBN-10: 1305090381 | ISBN-13: 9781305090385)
Workbook for Understanding Health Insurance  (ISBN-10: 1285737679 | ISBN-13: 9781285737676)
CourseMate Instant Access  (ISBN-10: 1285737717 | ISBN-13: 9781285737713)

Interested in a simple way to complement your text and course content with study and practice materials? Cengage Learning's CourseMate brings course concepts to life with interactive learning, study, and exam preparation tools that support the printed textbook. Watch reader comprehension soar as your class works with the printed textbook and the textbook-specific website. CourseMate goes beyond the book to deliver what you need!

Premium Web Site, 2 terms (12 months) Printed Access Card  (ISBN-10: 128587451X | ISBN-13: 9781285874517)

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

MindTap Medical Insurance & Coding, 2 terms (12 months) Instant Access for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement  (ISBN-10: 1305113152 | ISBN-13: 9781305113152)

MindTap Health Care for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement, 12th Edition is the digital learning solution that helps instructors engage and transform today's students into critical thinkers. Through paths of dynamic assignments and applications that you can personalize, real-time course analytics, and an accessible reader, MindTap helps you turn cookie cutter into cutting edge, apathy into engagement, and memorizers into higher-level thinkers. MindTap Health Care includes the latest code sets and guidelines, and covers important topics in the field like managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans.

Student Supplements

Workbook for Understanding Health Insurance  (ISBN-10: 1285737679 | ISBN-13: 9781285737676)
CourseMate Instant Access  (ISBN-10: 1285737717 | ISBN-13: 9781285737713)

The more you study, the better the results. Make the most of your study time by accessing everything you need to succeed in one place. CourseMate includes: An interactive eBook with highlighting, note taking, an interactive glossary, and interactive learning tools, including: Homework, Quizzes, Flashcards, PowerPoint® presentations, and more!

Premium Web Site Instant Access  (ISBN-10: 128587191X | ISBN-13: 9781285871912)

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

Premium Web Site, 2 terms (12 months) Printed Access Card  (ISBN-10: 128587451X | ISBN-13: 9781285874517)

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

LMS Integrated for MindTap Health Care, 2 terms (12 months) Instant Access  (ISBN-10: 1305113195 | ISBN-13: 9781305113190)

This access code will provide you with seamless access to your MindTap Health Care resources from within your campus Learning Management System. You will be prompted to enter this access code the first time that you click on a link in your course that includes Cengage content.

MindTap Medical Insurance & Coding, 2 terms (12 months) Instant Access for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement  (ISBN-10: 1305113152 | ISBN-13: 9781305113152)

MindTap Health Care for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement, 12th Edition provides you with the tools you need to better manage your limited time -- you can complete assignments whenever and wherever you are ready to learn with course material specially customized for you by your instructor and streamlined in one proven, easy-to-use interface. With an array of tools and apps -- from note taking to flashcards -- you'll get a true understanding of course concepts, helping you to achieve better grades and setting the groundwork for your future courses and a career in medical insurance billing.