Cengage Learning Understanding Health Insurance: A Guide to Billing and Reimbursement

Discover the essential tool to prepare for a career in medical insurance billing -- UNDERSTANDING HEALTH INSURANCE, 13E. This comprehensive, easy-to-understand, updated book presents the latest code sets and guidelines. You cover today’s most important topics, such as managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. Updates introduce new legislation that impacts health care, including the Affordable Care Act (Obamacare); ICD-10-CM coding; electronic health records; Medicaid Integrity Contractors; case mix management; hospital-acquired conditions; present on admission; and value-based purchasing. Practice exercises and the workbook (available separately) provides application-based assignments and case studies to reinforce your understanding, as well as CMRS, CPC-P, and CPB Mock Exams. New editions include online access to SimClaim™ CMS-1500 claims completion software and Optum’s EncoderPro.com Expert™. Review "I am a fan of this book and I do think the key terms are helpful in the learning process. From the time I added this book to our curriculum until now this book has grown and has only gotten better over time. It's a great book and has well written content. We are enjoying MindTap, and I do feel it is benefiting the students with hands-on examples...very pleased that the MindTtap walks students through the filling out of the insurance claims. I think the SimClaims are very helpful and provide hands-on experience for the students." The EncoderPRO Software is a major plus. The book provides a strong and detailed look at the main insurance companies in the USA - Medicare, Medicaid, and BC/BS. The product has MindTap which allows students many more options. I like the fact that there is an electronic grade book. There are also SimClaim assignments that students can accomplish through the web. The fact that it is all web-based is a MAJOR PLUS! I like MindTap. I think it is a great resource both for students and teachers. Great resources for students. Easily accessible. Gradebook is a major plus for professors." About the Author 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.