Understanding Health Insurance: A Guide to Billing and Reimbursement, 2024 Edition,
19th Edition

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.

• Michelle Green

  Michelle Green has been a SUNY Distinguished Teaching Professor in the health information technology department at Mohawk Valley Community College in Utica, New York, since 2017. Ms. Green held the position of SUNY Distinguished Teaching Professor in the physical and life sciences department at the State University of New York, College of Technology for more than 30 years. An active member of the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA), Ms. Green has been recognized both for her excellence in teaching and for her significant contributions to the health information management profession. She has earned numerous awards, including 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 and AHIMA’s FORE Triumph Educator Award. Ms. Green is a registered health information administrator (RHIA), a fellow of the American Health Information Management Association (FAHIMA) and a certified procedural coder (CPC). She earned an M.P.S. degree from Alfred University and a B.S. from Daemen College. Ms. Green has authored three popular textbooks related to coding, revenue management and health information management.

• The 2024 Edition includes updated health insurance and medical billing concepts, focusing on essential skills for healthcare professionals. New content covers hospital price transparency, CMS Measure Inventory Tool (CMIT), CMS Measures Under Consideration Entry/Review Information Tool (MERIT), measures under consideration (MUC), CMS National Quality Strategy and Medicare Value-Based Care Strategy. Professional billing content is clarified, new content on intelligent automation has been added and new illustrations of the original Medicare appeals process for Parts A and B are now included

• This latest edition includes carefully updated 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.

• Chapters 6-17 include new and revised ICD-10-CM, CPT® and HCPCS Level II codes for 2024. All explanations, exercises and reviews within these chapters reflect the latest coding changes, the most up-to-date coding guidelines and their impact on assigning codes.

• 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 is available on the accompanying MindTap Courseware. SimClaim offers multiple case studies that include present billing data and patient histories. Auto-graded features, like The Simulation, provide students with instant 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.

• Review questions incorporate payment calculations to provide students hands-on practice in calculating insurance or Medicare payments, co-payments and coinsurance.

• 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 11-7. Answers to exercises are available in the solutions and answer guide.

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.

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