Chapter 13 Procedural, Evaluation and Management, and HCPCS Coding Chapter outline I. Overview of Current Procedural Terminology (CPT) Coding A. Purpose of CPT B. Development of CPT II. Three Levels of Procedural Coding III. CPT…
Chapter 18 Hospital Billing and the UB-04 Chapter outline I. Hospital Versus Physician Office Billing and Coding II. Modern Hospital and Health Systems A. Emerging Issues III. Common Healthcare Facilities A. Acute Care Facilities B. Critical…
Chapter 8 Understanding Medicaid Chapter outline I. What is Medicaid? II. Evolution of Medicaid A. Temporary Assistance for Needy Families (TANF) B. Supplemental Security Income (SSI) 1. Eligibility 2. Eligibility Expansion C. Medicaid and Healthcare Reform III. Structure…
Chapter 14 The Patient Chapter outline I. Patient Expectations A. Professional Office Setting B. Relevant Paperwork and Questions C. Honoring Appointment Times D. Patient Load E. Getting Comfortable with the Healthcare Provider F. Privacy and Confidentiality G. Financial…
Chapter 2 Tools of the Trade A Career as a Health (Medical) Insurance Professional Chapter outline I. Your Future as a Health Insurance Professional A. Required Skills and Interests 1. Education 2. Preparation II. Job…
Chapter 11 Miscellaneous Carriers Workers’ Compensation and Disability Insurance Chapter outline I. Workers’ Compensation A. History B. Federal Legislation and Workers’ Compensation C. Eligibility 1. Exemptions 2. Benefits 3. Denial of Benefits and Appeals 4. Time Limits D. Workers’…
Chapter 17 Reimbursement Procedures Getting Paid Chapter outline I. Understanding Reimbursement Systems A. Types of Reimbursement 1. Fee-for-Service 2. Discounted Fee-for-Service 3. Prospective Payment System 4. Relative Value Units 5. Managed Care Organizations 6. Capitation II. Medicare and Reimbursement…
Chapter 3 The Legal and Ethical Side of Medical Insurance Chapter outline I. Medical Law and Liability A. Employer Liability B. Employee Liability II. Insurance and Contract Law A. Elements of a Legal Contract 1. Offer…
Chapter 5 Claim Submission Methods Chapter outline I. Overview of the Health Insurance Claims Process A. Two Basic Claims Submission Methods B. Proposed Revisions to the CMS-1500 (08-05) Form II. Electronic Claims III. Health Insurance…
Chapter 7 Unraveling the Mysteries of Managed Care Chapter outline I. What Is Managed Care? II. Common Types of Managed Care Organizations A. Preferred Provider Organization B. Health Maintenance Organization 1. Staff Model 2. Group Model…
