Professional Documents
Culture Documents
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Preface
Medical insurance plays an important role in the financial well-being of every
health care business. The regulatory environment of medical insurance is evolving
faster than ever. Changes due to health care reform require medical office professionals to acquire and maintain an in-depth understanding of compliance, electronic health records, medical coding, and more.
The seventh edition of Insurance in the Medical Office: From Patient to Payment emphasizes the medical billing cycleten steps that clearly identify all the components
needed to successfully manage the medical insurance claims process. Studying this
cycle shows how administrative medical assistants must first collect accurate patient
information and then be familiar with the rules and guidelines of each health plan in
order to submit proper documentation and follow up on payments. This ensures that
offices receive maximum, appropriate reimbursement for services provided. Without
an effective administrative staff, a medical office would have no cash flow!
So, why is studying medical insurance especially important for Medical Assisting
students? Medical Assistants (MAs) have the ability to work both clinically and administratively in the physician practice. This flexibility makes them valuable members of
the health care team. With the unpredictable nature of the economy, many practices are
doing more with less. This means that MAs may find themselves in a position where
they are working in a clinical capacity and also asked to assist with billing tasks. Furthermore, knowing about insurance, billing, and reimbursement is not only important
for MAs in the workforce, but this knowledge is also required for certification. Insurance
in the Medical Office is specifically targeted to Medical Assisting students and addresses
the role they play in contributing to the financial success of the medical office.
Here is an overview of the chapters, including how they relate to the steps of the
medical billing cycle:
Chapter
Coverage
Chapters 1, 2, 3
Covers Steps 1 through 4 of the medical billing cycle by introducing the major types of medical insurance,
payers, and regulators, as well as the medical billing cycle. Also covers HIPAA/HITECH Privacy, Security,
and Electronic Health Care Transactions/Code Sets/Breach Notification rules.
Chapters 4, 5, 6
Covers Steps 5 and 6 of the medical billing cycle, while building skills in correct coding procedures, use of
coding references, and compliance with proper linkage guidelines.
Covers Step 7 of the medical billing cycle and the general procedures for calculating reimbursement,
how to bill compliantly, and preparing and transmitting claims. Describes the major third-party private
and government sponsored payers procedures and regulations, along with specific filing guidelines.
Chapter 13
Covers Steps 8 through 10 of the medical billing cycle by explaining how to handle payments from payers,
follow up and appeal claims, and correctly bill and collect from patients.
Chapter 14
Chapter 15 (available at
www.mcgrawhillcreate.com)
Chapter 16 (available at
www.mcgrawhillcreate.com)
Covers ICD-9 and ICD-10 as an alternative to Chapter 4 for those programs still early in their transition from
ICD-9 to ICD-10.
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Preface
Many of the exercises involve insurance claims. These specific exercises may be
completed one of three ways:
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Chapter-by-Chapter
Chapter 1: New key termsaccounts payable (AP), cash flow, certification,
coding, documentation, electronic health record (EHR), health information
technology (HIT), medical assistant, medical billing cycle, medical documentation and billing cycle, out of pocket, PM/EHR, revenue cycle management
(RCM), statement, third-party payer. Chapter now focuses on the medical assistants role in revenue cycle management and clinical workflow; new coverage of
health information technology and practice management programs; updated
medical billing cycle; chapter now highlights the importance of certification and
continuing education.
Chapter 2: New key termsabuse, audit, breach, breach notification, business
associate (BA), Centers for Medicare and Medicaid Services (CMS), code set,
covered entity (CE), designated record set (DRS), electronic data interchange
(EDI), encounter, encryption, medical standards of care, Office of E-Health
Standards and Services (OESS), Office of Inspector General (OIG), password,
transaction. New coverage and discussion on the Affordable Care Act and the
Health Information Technology for Economic and Clinical Act (HITECH).
Chapter 3: New to this edition, this chapter focuses on the patient encounter
and billing information. Simulated chapter exercises include creating a new patient account, updating an existing patient account, verifying patient eligibility,
and entering a patients insurance information.
Chapter 4: (Chapter 3 in the previous edition) Updated for ICD-10. New Key
termscombination code, diagnostic statement, eponym, exclusion notes,
GEM, ICD-10-CM, ICD-10-CM Official Guidelines for Coding and Reporting, inclusion notes, Index to External Causes, laterality, manifestation, NEC
(not elsewhere classified), Neoplasm Table, nonessential modifier, NOS (not otherwise specified), outpatient, placeholder character (x) sequelae, seventhcharacter extension, Table of Drugs and Chemicals, Z Code. Simulated chapter
exercise covers entering a patients diagnosis.
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Instructors Resources
Supplement
Features
Lesson Plans
Answer Keys for all exercises
Documentation of Steps and Screenshots for Simulated Medisoft and CMS-1500 Exercises
PowerPoint Presentations
(organized by Learning
Outcomes)
Key Terms
Key Concepts
Teaching Notes
Electronic Testbank
Medisoft Exercises
Resources
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Preface
Correlations of the Learning Outcomes to Accrediting Bodies such as ABHES CAAHEP, and CAHIIM
Sample Syllabi
Conversion Guide between sixth and seventh editions
Asset Mapre-cap of the key instructor resources, as well as information on the content available through
Connect Plus
You can rely on the following materials to help you and your students work through
the material in the book, all of which are available on the books website, www.mhhe.
com/newbycarr (instructors can request a password through their sales representative):
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Nikita Carr, CPC, has instructed and developed curricula for medical assisting
and medical billing and coding programs in a variety of academic settings. Nikita
has taught in the Adult Education program for Chesterfield County Public Schools
and coordinated the Medical Billing and Coding Specialist program at the Centura
College, Midlothian, Virginia, campus. Nikita has worked with the Allied Health
Division of McGraw-Hill in the production of several billing, insurance, and coding titles. Prior to her educational career Nikita worked over fifteen years in health
care clinically and administratively for hospitals, long-term care facilities, and physician practices.
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