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.
A comprehensive guide designed to help consumers understand the American health insurance system so that they can obtain the benefits to which they are entitled. Epstein explains the ins and outs of both new and traditional health insurance plans, including traditional individual and group policies, HMOs and other types of managed care plans, self-funded plans, Medicare, Medicare HMOs, Medigap, long-term care, COBRA, CHAMPUS, and Medical Savings Accounts.
Written by a nationally syndicated columnist, this useful volume also deals with special health insurance issues related to children, adults with special needs, and individuals who may need long-term care. In addition, Epstein provides valuable information for individuals who are in the process of changing jobs or making changes in their marital or family status, choosing a health insurance plan, or arranging long-term care-including placement in a nursing home or an assisted-living facility-for an aging parent. The book has a practical focus with a variety of tables and worksheets to help consumers establish a system for preventing health insurance problems, and for dealing with any health insurance problems that may arise. It also contains answers to common questions about health insurance, and provides a list of organizations that offer detailed information and advice in regard to specific health insurance problems.
Congress has seen a renewed interest in the market for private health insurance since the passage of the Patient Protection and Affordable Care Act (ACA). This book provides an overview of private-sector (as opposed to government-provided) health insurance. It serves as an introduction to health insurance from the point of view of many consumers under the age of 65. Furthermore, the book provides background information about modifying or building on the current health insurance system; discusses how understanding the potential impact of such proposals requires a working knowledge of how health insurance is provided, purchased, and regulated; and describes various ACA provisions that affect the private insurance market.
Healthcare is now practiced in a different financial and delivery system than it was two decades ago. Currently managed care defines what is treated, how, by whom and for what reimbursement. Mental health professionals have been greatly impacted by these changes to their practice, and yet, there is little understanding of exactly what it is and where it is going. The present volume explores these issues, prospects and opportunities from the vantage of mental health /medical professionals and managed care executives who are in the very process of implementing changes to the existing system of managed care. Behavioral healthcare will be integrated into medical practice in the future for sound clinical and economic reasons. The present volume, edited by four prominent mental health professionals provides a roadmap of the emerging directions integrated behavioral healthcare is taking and lays out the steps the mental health professional needs to take--in training, and modifying her/his clinical practice--to adapt to the new system of healthcare.
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