Medical Insurance: A Revenue Cycle Process Approach

Nenna L. Bayes , AAS, BBA, M.Ed., CPC, has coauthoredand reviewed various titles within the medical administrative fields. She earned anassociate of applied business degree, a bachelor of business administration degree,and a masters of arts in education from Morehead State University. During her tenure,she has taught numerous courses within the administrative and medical administrativecurriculum. She is a professor in and the program coordinator for the OfficeSystems Technology and Medical Information Technology programs at AshlandCommunity and Technology College in Ashland, Kentucky, and has received manyteaching excellence awards. She is also a certified professional coder (CPC). Prior toteaching, she worked in various medical office environments. Additionally, she is amember of the American Academy of Professional Coders (AAPC) and the AmericanHealth Information Management Association (AHIMA).She lives in Flatwoods, Kentucky, with her husband and is blessed to have twochildren and two granddaughters . She is actively involved in music and enjoyscamping in her leisure time. Cynthia Newby, CPC, CPC-P, is a long-serving author who works closely with McGraw-Hill Education instructional development staff to develop excellent MIBC programs. Cynthia is a graduate of Hood College and a trustee of that institution as well as her local animal shelter and library. Amy L. Blochowiak, MBA, RHIT, ACS, AIAA, AIRC, ARA,FLHC, FLMI, HCSA, HIA, HIPAA, MHP, PCS, SILA-F, has coauthored and reviewed various textbooks within the medical administrative and insurance fields. She earned associate degrees in medical office mid-management and health information technology from Northeast Wisconsin Technical College, bachelor’s degrees in both business administration and marketing from Lakeland College, and a master’s degree in business administration from Lakeland College. She is currently the program director and instructor for the Healthcare Business Professional program at Northeast Wisconsin Technical College, where she sits on many committees and shares her passion for student success. Prior to teaching, she worked in various insurance industry roles for over 16 years. She is a member of the American Health Information Management Association (AHIMA).

• Part 1 WORKING WITH MEDICAL INSURANCE AND BILLINGChapter 1 Introduction to the Revenue Cycle Chapter 2 Electronic Health Records, HIPAA, and HITECH: Sharing and Protecting Patients’ Health InformationChapter 3 Patient Encounters and Billing InformationPart 2 CLAIM CODINGChapter 4 Diagnostic Coding: ICD-10-CMChapter 5 Procedural Coding: CPT and HCPCSChapter 6 Visit Charges and Compliant BillingPart 3 CLAIMSChapter 7 Healthcare Claim Preparation and TransmissionChapter 8 Private Payers/ACA PlansChapter 9 MedicareChapter 10 Medicaid Chapter 11 TRICARE and CHAMPVAChapter 12 Workers’ Compensation and Disability/Automotive InsurancePart 4 CLAIM FOLLOW-UP AND PAYMENT PROCESSINGChapter 13 Payments (RAs), Appeals, and Secondary ClaimsChapter 14 Patient Billing and CollectionsChapter 15 Primary Case StudiesChapter 16 RA/Secondary Case StudiesPart 5 HOSPITAL SERVICESChapter 17 Hospital Billing and Reimbursement