Table of Contents

UNIT I BUILDING A FOUNDATION
1 The Origins of Health Insurance
2 Tools of the Trade: A Career as a Health Insurance Professional
3 The Legal and Ethical Side of Health Insurance
4 Healthcare Reform: Coverage Types and Sources
5 The Patient and the Billing Process
UNIT II HEALTH INSURANCE BASICS
6 Reimbursement Models
7 Understanding Managed Care
8 Understanding Medicare
9 Understanding Medicaid
10 Understanding Military Carriers
11 Understanding Miscellaneous Carriers: Workers' Compensation and Disability Insurance
UNIT III CLAIMS SUBMISSION
12 Claim Submission Methods
13 Diagnostic Coding
14 Procedural, Evaluation and Management, and HCPCS Coding
15 Claims Management
UNIT IV ADVANCED APPLICATION
16 The Role of Computers in Health Insurance
17 Reimbursement Procedures: Getting Paid
18 Hospital Billing and the UB-04
Appendix A: Sample Blank CMS-1500 (02/12)
Appendix B: CMS-1500 Claim Forms and Completion Instructions
Appendix C: UB-04 Claim Forms and Completion Instructions
Glossary
Index

About the Author

Julie Pepper has spent her entire career in health care as a medical assistant in a variety of offices and clinics, developing expertise in the electronic health record and as an instructor in a medical assistant program. She combines her education in dietetics with her clinical and administrative experience as an instructor in the Medical Assisting program at Chippewa Valley Technical College in Wisconsin, where she taught for 21 years and from where she retired from teaching. Julie was also the program director for the college's Health Navigator program. She has served as a reviewer and contributor to numerous Medical Assisting educational products over the last decade, including Sim Chart for the Medical Office. She currently serves as the sole author of The Electronic Health Record for the Physician's Office and The Simulated Administrative Medical Office. She has been leading author of Beik's Health Insurance Today text and workbook since the 8th edition. She also has been a coauthor for Kinn's Medical Assisting Fundamentals, Kinn's The Medical Assistant, and Today's Medical Assistant. Julie strives to bring the needed information to students in a way to keep them interested in learning all that they need to be wonderful employees working in healthcare.