Guide to Medical Billing

(NOTE: Each chapter contains a Summary, Assignments, Questions for Review , and Honors Certification™) 1. Introduction. The Historical Perspective Job Roles and Duties The Medical Team Types of Healthcare Settings Technology and the Medical Biller Attitudes that Make a Successful Medical Biller Workplace Professionalism Interpersonal Skills Professional Appearance Stress Pre-Vacation Work Planning Detail Orientation Certification Programs for Medical Billers Exercises 1 - 1 through 1 - 3 2. Time Management and Prioritizing. Prioritization Pressure Projects Time Management Counting Time Backwards Overlapping Projects Exercises 2 - 1 through 2 - 2 3. Legal Issues. Privacy Guidelines Fraud HIPAA and Fraud and Abuse Embezzlement Disclaimers Legal Damages Medical Ethics Subpoenas Instances in Which the Patient Should Be Notified and the File Notated 4. Clinical Records Management. Medical Charts Filing the Chart Medical Documentation Rules Signature Cards Retention of Records Storing Medical Records Electronic Medical Charting Computerized Files Record Transfers 5. Medical Documentation Forms. Patient Information Sheet Release of Information Form Assignment of Benefits Form Patient History Form Insurance Verification Additional Suggestions Exercise 5 - 1 6. Contract Interpretation. Blue Cross/ Blue Shield Contract Provisions Contract Benefits Exclusions Allowed Amounts Pre-Certification of Inpatient Admissions Utilization Review Second Surgical Opinion Consultations Exercises 6 - 1 through 6 - 5 Sample Insurance Contract 7. Medicare. TEFRA/DEFRA Medicare Eligibility Providers of Service The Two Parts of Medicare Approved or Reasonable Charges Billing Medicare Services Assignment of Benefits Coordinating Medicare w/Other Insurance Estimating Medicare Coverage Diagnosis-Related Group Billing Medicare Denials Medicare Advance Notice The Medicare Appeals Process Medical Fraud and Abuse Medicare Supplement Medicare and Veterans Medicare and Managed Care Medicare Notice of Non-Coverage Medicare Timeliness Reports Exercise 7 - 1 8. Medicaid. Medicaid Billing Procedures Treatment Authorization Request Reimbursement from Medicaid 9. Workers'Compensation. Employee Activities Time Limits Types of Claims Benefits of Workers'Compensation Workers'Compensation Reform Medical Service Order Patient Records Doctor's First Report Subsequent Progress Reports Physician's Final Report Delay of Adjudication Billing for Workers'Compensation Delinquent ClaimICDC Publishing Inc. Staff is the author of 'Guide to Medical Billing' with ISBN 9780131718494 and ISBN 0131718495.