Understanding Health Insurance: A Guide to Billing and Reimbursement, 8th Edition is a comprehensive source for teaching the subject of health insurance and reimbursement. The book contains chapters on introductory information on the health insurance field, managed health care, legal and regulatory issues, coding systems, reimbursement methodologies, coding for medical necessity, and common health insurance plans. Each chapter contains exercises to illustrate content and reinforce learning. Numerous opportunities are provided throughout the book for manual completion of CMS-1500 claims. A CD-ROM at the back of the book allows for electronic data entry of CMS-1500 claim form information. End of chapter review questions in objective format (e.g., multiple choice) test learners on their understanding of book content. Appendices I and II provide case studies that are also included on the Student Practice CD-ROM. Additional appendices provide instruction in dental claims processing and completion of the UB-92 (claim used for inpatient and outpatient hospital claims). The accompanying workbook provides application based assignments for each chapter, additional content review (multiple choice questions), and additional case studies for practice in completing CMS-1500 claims. This edition of the book contains the most up to date information regarding health insurance claims processing and coding and reimbursement issues.
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.
Statistics published by the U. S. Department of Commerce (1980) indicate that in 1977 we spent 8. 1% of our gross national product (GNP) on life, health, property-casualty, and other forms of insurance. An additional 5. 7% was used to pay the Social Security tax, which is another form of insurance premium, for a total of 14. 8% of the GNP. Although insurance had its historical origin in marine insurance, it has now developed into one of the major industries of the American economy and extends into many areas of economic activity. One area where growth has been particularly strong is the medical sector. Health insurance is a major institution in all industrialized countries. It became a government responsibility in 1883 when Bismarck intro- duced a compulsory program of health insurance for industrial workers in Germany. Programs for workers in various industrial and income categories soon followed in other European countries-Austria (1888), Hungary (1891), Norway (1909), Servia (1910), Great Britain (1911), and Russia and Romania (1912) (Rubinow, 1913:250). Programs in these countries were extended in subsequent years, and other countries in Europe followed with their own programs. Consequently, today most industrial countries have universal or near-universal health insurance coverage. In the United States the issue of national health insurance has been seriously debated since just prior to World War I, and polling data since the 1930s show that a substantial majority of the public has been supportive of such a program (Erskine, 1975).
Pocket Principles for the Insurance Business provides daily motivation for those in the insurance industry who wish to embrace adversity in order to reach success. As a seasoned life insurance salesman who has qualified for the million dollar roundtable every year he's been in the business, B.A. Newman truly understands the ups and downs of a business that has a retention rate of just 12 percent, and he provides the tools necessary to face rejection and rely on it as a positive influence when success seems unattainable. His inspirational snippets include relational and easily applied advice such as: work for the best companies, listen to your clients, love what you do, and don't sacrifice your reputation to make a sale. In a profession that can sometimes seem more like a roller coaster ride than smooth sailing, these motivational quotes will help inspire anyone to do great things ... every day. "Ben's Principles help our producers keep striving for goal achievement even on their toughest days." -Michael T. Fleming, CLU, ChFC General Manager & Financial Advisor, Mass Financial Group, Inc. "Pockets principles will have an impact on my first Million Dollar Roundtable qualification ..." Mark E. Kull, Financial Representative Northwestern Mutual Financial Network, Louisville, Kentucky AUTHOR BIO Benjamin Newman is a life insurance salesman who is a several-time qualifier for the million dollar roundtable. He is Founder of Continued Fight, LLC, a company that helps organizations overcome challenges and seek positive outcomes. Benjamin and his wife Ami live in St. Louis, Missouri, with their son J. Isaac.
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