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See Most Recent Edition

Understanding Health Insurance: A Guide to Billing and Reimbursement, 2023 Edition, 18th Edition

Michelle A. Green

  • Copyright 2024
  • {{checkPublicationMessage('Published', '2023-01-17T00:00:00+0000')}}
Starting At $77.95 See pricing and ISBN options
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Understanding Health Insurance: A Guide to Billing and Reimbursement, 2023 Edition 18th Edition by Michelle A. Green
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Overview

Prepare students for successful careers in revenue management, medical billing or health insurance processing with Green's UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2023 Edition. Updated annually, this reader-friendly resource highlights the latest developments in health care insurance and revenue management, as well as recent changes to ICD-10-CM, HCPCS Level II and CPT® 2023 codes and coding guidelines. This edition introduces the MIPS Value Pathways; explains major changes for selecting codes in the CPT 2023 evaluation and management section; and clarifies key health insurance concepts such as risk adjustments, hierarchical condition category coding, patient portals, balance billing, coordination of benefits, third-party administrators, Medicare appeals process and whistleblowers. The author has also reorganized the chapter on ICD-10-CM Coding to better align with official coding guidelines from The Centers for Medicare & Medicaid Services (CMS). Students will gain valuable knowledge of health insurance, managed care, legal and regulatory issues, coding systems and compliance, reimbursement and revenue management, clinical documentation, coding for medical necessity and common health insurance plans. In addition, an accompanying workbook provides application-based assignments and case studies, while MindTap online resources include specialized software for SimClaim CMS-1500 claims completion.

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Meet the Authors

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Michelle A. Green

Michelle Green has served in the capacity of full-time or adjunct faculty member as needed since 2017, and during Spring 2023 was named interim program director in the health information technology department at Mohawk Valley Community College in Utica, New York. She was the SUNY Distinguished Teaching Professor in the physical and life sciences department at the State University of New York College of Technology at Alfred for more than 30 years. She has authored three popular textbooks related to coding, revenue management and health information management. An active member of the AAPC and American Health Information Management Association, Green has been recognized for her excellence in teaching as well as her significant contributions to the health information management profession. Her numerous accolades include the State University of New York Chancellor's Award for Excellence in Teaching, Alfred State College's Alumni Association Teacher of the Year, Who's Who Among America's Teachers, AHIMA's FORE Triumph Educator Award and NYHIMA’s Educator Award. In addition, she is a Registered Health Information Administrator, a fellow of the American Health Information Management Association and a Certified Professional Coder. She earned an MPS from Alfred University and a Bachelor of Science from Daemen College.

What's New

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  • The 2023 Edition features updated health insurance and medical billing concepts throughout the text, focusing on the MIPS Value Pathways and major changes for selecting codes in the CPT® 2023 evaluation and management section. The new edition also clarifies key health insurance concepts such as risk adjustments, the hierarchical condition category system, patient portals, balance billing, coordination of benefits, third-party administrators, Medicare appeals process and whistleblowers.
  • The author has carefully updated all instructions for completing insurance claims within chapters 11-17. Revisions reflect the latest requirements to prepare students to seamlessly transition their skills from academic to professional environments.
  • Updated for 2023, chapter 3 provides current information on revenue management, managing patients, encounter forms and chargemasters, processing an insurance claim, posting charges to patient accounts, monitoring and auditing for revenue management. Featuring similar updates for today's industry, chapter 4 covers the insurance claim cycle, maintaining insurance claim files, denied claims, the appeals process and credit and collections.
  • Updates to ICD-10-CM content reflect the latest changes and developments students need to know, reorganizing key coding concepts to align them with official CMS coding guidelines.
  • CPT® codes and concepts have been updated throughout this edition, including an emphasis on major changes for assigning codes to the evaluation and management section in CPT 2023.
  • Chapters 6-17 include new and revised ICD-10-CM, CPT® and HCPCS Level II codes for 2023. All explanations, exercises and reviews within these chapters reflect the latest coding changes, the most up-to-date coding guidelines and their impact on the assigning of codes.

Features

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  • Clear learning objectives at the beginning of each chapter allow students to self-assess comprehension of chapter content. In addition, boldfaced key terms appear throughout each chapter to help students master the technical vocabulary associated with billing, coding, reimbursement and claims processing. The text's proven learning design methodology clearly maps chapter content both to major topics to be covered and to well-defined learning objectives.
  • Clear instructions for completing CMS-1500 insurance claims reflect current requirements, including any recent changes. Updates to instructions appear throughout the textbook and SimClaim software, as well as within the answer keys in the solutions and answer guide. Case studies in the SimClaim software present billing data and patient histories, which students can use to complete data entry of CMS-1500 claims and receive immediate feedback.
  • The student companion website features the latest content on ICD-10-PCS coding and official guidelines, as well as a variety of application exercises to strengthen coding skills. Answer keys are available on the password-protected instructor's companion website.
  • Review questions incorporate payment calculations to give students hands-on practice in calculating insurance or Medicare payments, co-payments and coinsurance, encouraging them to develop these important skills for career success.
  • Multiple-choice review questions help accurately assess student comprehension of chapter content, while additional questions focus on gauging understanding of key concepts and applications.
  • To gain valuable hands-on practice with key concepts, students can complete coding exercises throughout chapters 6-8 and 10, as well as claims completion exercises in chapters 11-17. Answers to all of these exercises are available in the solutions and answer guide to make assessment easier.

Table of Contents

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1. Health Insurance Specialist Career.
2. Introduction to Health Insurance and Managed Care.
3. Introduction to Revenue Management.
4. Revenue Management: Insurance Claims, Denied Claims and Appeals and Credit and Collections.
5. Legal Aspects of Health Insurance and Reimbursement.
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. BlueCross BlueShield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers’ Compensation.
Appendices.
Bibliography.
Glossary.
Index.

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MindTap Options

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MindTap
Each MindTap product offers the full, mobile-ready textbook combined with superior and proven learning tools at one affordable price. Students who purchase digital access can add a print option at any time when a print option is available for their course.

This Cengage solution can be seamlessly integrated into most Learning Management Systems (Blackboard, Brightspace by D2L, Canvas, Moodle, and more) but does require a different ISBN for access codes. Please work with your Cengage Learning Consultant to ensure the proper course set up and ordering information. For additional information, please visit the LMS Integration site.

Standalone Digital Access — Ultimate Value

Recommended and most popular

  • ISBN-10: 0357764099
  • ISBN-13: 9780357764091
  • RETAIL $99.95
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Textbook Only Options

Traditional eBook and Print Options

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  • ISBN-10: 0357764153
  • ISBN-13: 9780357764152
  • RETAIL $77.95

  • ISBN-10: 0357764072
  • ISBN-13: 9780357764077
  • RETAIL $103.95

  • ISBN-10: 0357764064
  • ISBN-13: 9780357764060
  • RETAIL $263.95
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Supplements

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Cengage provides a range of supplements that are updated in coordination with the main title selection. For more information about these supplements, contact your Learning Consultant.

FOR INSTRUCTORS

Student Workbook for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement - 2023

ISBN: 9780357764077
The student workbook is designed to help you retain key chapter content. Included within this resource are chapter objective questions; key-term definition queries; and multiple choice, fill-in-the-blank, and true-or-false problems.

FOR STUDENTS

Student Workbook for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement - 2023

ISBN: 9780357764077
The student workbook is designed to help you retain key chapter content. Included within this resource are chapter objective questions; key-term definition queries; and multiple choice, fill-in-the-blank, and true-or-false problems.

MindTap for Green's Understanding Health Insurance: A Guide to Billing and Reimbursement - 2023 Edition, 2 terms Instant Access

ISBN: 9780357764091
MindTap for Green's UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2023 Edition, is a comprehensive online learning solution that powers students from memorization to mastery. It gives you complete control of your course--to provide engaging content, to challenge every individual and to build student confidence. MindTap is easy to use and implement, and it includes a complete ebook and well-organized learning path following the organization of the core textbook. MindTap easily integrates with your school's LMS and provides integrated gradebook features for auto-graded assessments. Customize the interactive syllabi, emphasize the most important topics and add your own material or notes in the ebook.