Efnisyfirlit

• Cover
• Introduction
  • About This Book
  • Foolish Assumptions
  • Icons Used in This Book
  • Beyond the Book
  • Where to Go from Here
• Part 1: Getting to Know Medical Billing and Coding
  • Chapter 1: Dipping Your Toes into Medical Billing and Coding
    • Coding versus Billing: They Really Are Two Jobs
    • Following a Day in the Life of a Claim
    • Keeping Abreast of What Every Biller/Coder Needs to Know
    • Deciding Which Job Is Right for You
    • Prepping for Your Career: Training Programs and Certifications
    • Planning for the Future
  • Chapter 2: Exploring the Billing and Coding Professions
    • Looking at the Medical Coding Job
    • Breaking Down the Medical Biller’s Job
    • In Tandem: Working Together or Doing Both Jobs Yourself?
  • Chapter 3: Weighing Your Employment Options
    • Choosing Your Environment: Doctor’s Office, Hospital, and Others
    • Remote Access: Setting up Off-Site
    • Reviewing Other Work Options: Freelancing, Temping, and More
    • Heeding a Word of Advice for New Coders
• Part 2: Boning Up on the Need-to-Knows of Your Profession
  • Chapter 4: Compliance: Understanding the Rules
    • You Rule! Meeting the Rule Makers
    • Complying with HIPAA
    • Unbundling the Compliance Bundle
    • Getting the Most out of the Dreaded Audit
  • Chapter 5: Not-So-Strange Bedfellows: Medical Terminology and Medical Necessity
    • Brushing Up on Basic Anatomy
    • Say What? Deciphering Medical Terminology
    • Understanding Medical Necessity
    • Scrubbing In: Proving Medical Necessity for Surgical Procedures
    • Connecting with the World of Evaluation and Management Codes
  • Chapter 6: Getting to Know the Payers
    • Wading through Commercial Insurance Payers
    • Medicare: Meeting the Chief Government Payer
    • Working with Other Government Payers
• Part 3: Becoming a Professional: Getting Certified
  • Chapter 7: Your Basic Certification Options, Courtesy of the AAPC and AHIMA
    • Introducing the Two Main Credentialing Organizations: AAPC and AHIMA
    • Looking at the Basic Certifications
    • Choosing the Certification That’s Right for You
    • Examining the Exams: A Quick Review of the Main Tests
  • Chapter 8: The Path to Certification: Finding a Study Program
    • The Big Picture: Thinking about Your Degree and Career Objectives
    • Considering the Time Commitment
    • First Things First: Squaring Away Your Prerequisites
    • Picking a Program of Study
    • Caveat Emptor: Watching Out for Diploma Mills
  • Chapter 9: Signing Up and Preparing for the Certification Exam
    • Establishing a Study Routine and Strategy
    • Focusing on the Right Topics
    • Preparing Yourself for Test Day
    • Signing Up for and Taking the Big Test
  • Chapter 10: Adding Street Cred: Specialty Certifications and Continuing Ed
    • Introducing Specialty Certification Options
    • Building on Your Cred with Continuing Education
• Part 4: Dealing and Succeeding with Nitty-Gritty On-the-Job Details
  • Chapter 11: Processing a Run-of-the-Mill Claim: An Overview
    • Dreaming of the Perfect Billing Scenario
    • Delving into the Details: Contract Specifics
    • Covering Your Bases: Referrals and Preauthorization
    • Tracking Your Claim from Submission to Payment
    • Fighting for Proper Payment: Filing an Appeal with the Payer
  • Chapter 12: Homing In on How to Prepare an Error-Free Claim
    • Assigning CPT Codes
    • Applying Modifiers Correctly
    • Looking for Money Left on the Table
    • Checking and Double-Checking Your Documentation
  • Chapter 13: From Clearinghouse to Accounts Receivable to Money in the Pocket
    • Spending Time in the Clearinghouse
    • Facing Factors Affecting Reimbursement Amounts
    • Payment or Denial: Being in the Hands of the Payer
    • Breaking Down the Remittance Advice
  • Chapter 14: Handling Disputes and Appeals
    • Dealing with Disputes Involving Contract and Non-Contracted Payers
    • Knowing When to File an Appeal: General Guidelines
    • The Art of the Appeal: Understanding the Basics before You Begin
    • Going through an Appeal, Step by Step
    • Appealing Medicare Processing
    • Appealing a Workers’ Comp Claim
  • Chapter 15: Keeping Up with the Rest of the World
    • WHO’s on First: Providing Data to the World Health Organization
    • Charting Your Course with ICD
    • Moving beyond ICD-10
• Part 5: Working with Stakeholders
  • Chapter 16: Dealing with Commercial Insurance Claims
    • Meeting Commercial Insurance
    • Cashing In with Commercial Payers
    • Knowing What’s What: Verifying the Patient’s Plan and Coverage
  • Chapter 17: Caring about Medicare and Medicaid
    • Brushing Up on Medicare Basics
    • Working with Medicare Claims
    • Deciding What Gets Paid
    • Working with Medicare Contractors
    • Doing Business with Medicare Part C Plans
    • Verifying Coverage and Plan Requirements
  • Chapter 18: Coding Ethics: Being an Advocate for Your Employer
    • Playing the Part of the Professional Medical Biller/Coder
    • Protecting Yourself and Your Integrity
    • Getting the Most Bang for Your Client’s Buck — Honestly
• Part 6: The Part of Tens
  • Chapter 19: Ten Common Billing and Coding Mistakes and How to Avoid Them
    • Being Dishonest
    • Shifting the Blame
    • Billing More than Is Documented
    • Unbundling Incorrectly
    • Ignoring an Error
    • Mishandling an Overpayment
    • Failing to Protect Patients from Out-of-Network Penalties
    • Failing to Verify Prior Authorization
    • Breaking Patient Confidentiality
    • Following the Lead of an Unscrupulous Manager
  • Chapter 20: Ten Acronyms to Burn into Your Brain
    • ACA: Patient Protection and Affordable Care Act
    • ACO: Accountable Care Organization
    • CDI: Clinical Documentation Improvement
    • CMS: Centers for Medicare & Medicaid Services
    • EHR: Electronic Health Record
    • EOB: Explanation of Benefits
    • HIPAA: Health Insurance Portability and Accountability Act
    • INN: In-Network
    • NCCI: National Correct Coding Initiative
    • OON: Out-of-Network
  • Chapter 21: Ten (Plus One) Tips from Billing and Coding Pros
    • Insist on Proper Documentation
    • Verify Patient Benefits
    • Get Vital Patient Info at Check-In
    • Review the Documentation ASAP
    • Set Up a System to Ensure Accuracy
    • Play Nice with Others
    • Follow Up on Accounts Receivable Daily
    • Be a Bulldog on the Phone
    • Know Your Payer Contracts by Heart
    • Create a File System That Lets You Find What You Need
    • Make Payers Show You the Money!
• Glossary
• Index
• About the Author
• Connect with Dummies
• End User License Agreement

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