Prepare students for careers in health information management and medical billing and insurance processing with Green's UNDERSTANDING HEALTH INSURANCE, 14E. This comprehensive, inviting book presents the latest code sets, coding guidelines, and health plan claims completion instructions. Students examine managed care, legal and regulatory issues, coding systems and compliance, reimbursement, clinical documentation improvement, coding for medical necessity, and common health insurance. Updates address new legislation that impacts health care, including changes to the Affordable Care Act (Obamacare); ICD-10-CM, CPT, and HCPCS level II coding; revenue cycle management; and individual health plans. An accompanying workbook provides application assignments; case studies; review; and CMRS, CPC-P, and CPB mock exams. This edition also offers SimClaim™ CMS-1500 claims completion software online.

1. Health Insurance Specialist Career.
2. Introduction to Health Insurance.
3. Managed Health Care.
4. Revenue Cycle Management.
5. Legal and Regulatory Issues.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding Compliance, Clinical Documentation Improvement, and Coding for Medical Necessity.
11. CMS-1500 and UB-04 Claims.
12. Commercial Insurance.
13. Blue Cross Blue Shield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers’ Compensation.
Appendices.
Bibliography.
Glossary.
Index.

Prepare students for careers in health information management and medical billing and insurance processing with Green's UNDERSTANDING HEALTH INSURANCE, 14E. This comprehensive, inviting book presents the latest code sets, coding guidelines, and health plan claims completion instructions. Students examine managed care, legal and regulatory issues, coding systems and compliance, reimbursement, clinical documentation improvement, coding for medical necessity, and common health insurance. Updates address new legislation that impacts health care, including changes to the Affordable Care Act (Obamacare); ICD-10-CM, CPT, and HCPCS level II coding; revenue cycle management; and individual health plans. An accompanying workbook provides application assignments; case studies; review; and CMRS, CPC-P, and CPB mock exams. This edition also offers SimClaim™ CMS-1500 claims completion software online. MERGED PRESENTATION OF REVENUE CYCLE MANAGEMENT NOW APPEARS IN ONE LOCATION. The author has relocated all revenue cycle management topics to Chapter 4 to centralize content. In addition, the author has updated all material to reflect the latest changes. CONTENT DETAILS COMPLIANCE AND DOCUMENTATION IN CODING WITH CLEAR EXAMPLES TO ENSURE UNDERSTANDING. Coding compliance, clinical documentation improvement, and coding for medical necessity topics are located in Chapter 10 with examples that further detail and clarify principles. NEW SIMCLAIM™ SOFTWARE ALLOWS STUDENTS TO APPLY CMS-1500 CLAIMS COMPLETION INSTRUCTIONS. The software works seamlessly with Chapters 11 through 17, providing important hands-on reinforcement of concepts. In addition, the workbook contains additional case studies for student practice. MOCK CERTIFICATION EXAMS PROVIDE VALUABLE OPPORTUNITIES TO PRACTICE TEST-TAKING TECHNIQUES. These mock exams, included in the workbook, show students what to expect on the actual certification exams. KEY TERMS, SECTION HEADINGS, AND LEARNING OBJECTIVES AT THE BEGINNING OF EACH CHAPTER ORGANIZE AND DIRECT LEARNING. Students can use these learning tools at the beginning of each chapter as a self-test for checking comprehension and mastery of chapter content. Boldfaced key terms appear throughout each chapter to help learners master the technical vocabulary associated with claims processing. CODING AND CLAIMS COMPLETION EXERCISES ALLOW STUDENTS TO PRACTICE THE CONCEPTS AS THEY PROGRESS. Students work with coding exercises throughout Chapters 6, 7, 8, and 10 and claims completion exercises throughout Chapters 11 through 17. Answers to exercises are available for your convenience in checking work. CPT, HCPCS LEVEL II, AND ICD-10-CM COVERAGE PRESENTS THE LATEST INFORMATION, EXAMPLES, AND EXERCISES. Students work with the most recent coding information. Numerous examples, skill-building exercise and detailed content prepares students for challenges and ongoing changes they will encounter on the job. STUDENTS PRACTICE COMPLETING BOTH MANUAL AND ONLINE CLAIMS. CMS-1500 claims appear throughout the text to provide valuable practice with manual claims completion. In addition, SimClaim™ practice software, available online with each new text, lets students work with claims electronically. The UB-04 claim appears in chapter 11 with its claims completion instructions. NUMEROUS EXAMPLES CLEARLY ILLUSTRATE HOW TO APPLY PRINCIPLES STUDENTS ARE LEARNING. Memorable examples in each chapter demonstrate how to correctly apply rules and guidelines presented in that chapter.