Books : Business & Investing : Personal Finance : Insurance : Health

• You're self-employed, an independent contractor, or your employer doesn't provide health insurance (you can probably get coverage on your own for about $94/month—a fraction of what an employer would have to pay for the same coverage)
• You are employed and pay extra to cover your spouse or children under your employer-sponsored plan—you may save 50% by taking them off your employer plan
• You own a small business and are getting killed by double-digit premium increases—you can now give employees tax-free money to buy their own plans and get your company out of the health insurance business

The book also explains in detail the best solutions for you if:

• You can't find affordable health insurance because you or a child have an expensive preexisting medical problem (your state has a program to provide you with guaranteed coverage )
• You're currently putting money into an IRA or a 401(k)—because you don't realize that an HSA is always a better option
• You're unsure how you or your parents will be able to afford health insurance during retirement, or how to maximize benefits from Medicare—including the new Part D prescription drug plan

The New Health Insurance Solution is the definitive guide to the new ways every American can now get affordable health care—without an employer.

PAUL ZANE PILZER is a world-renowned economist, a former advisor in two White House administrations, an entrepreneur/employer, an award-winning adjunct professor at NYU, and a New York Times bestselling author.

• Procedural (CPT and HCPCS) and diagnostic (ICD-9-CM) coding and documentation are emphasized, since they are the keystones to obtaining maximum reimbursement.
• Key terms are bolded at first mention, explained within the context of the discussion, and defined in the glossary.
• Separate chapters on Electronic Data Interchange and HIPAA Compliance and Privacy in Insurance Billing provide essential knowledge of electronic claims filing, informing you of submission guidelines used in the majority of medical offices today.
• Icons clearly identify each insurance payer with a specific color and graphic, making specific information easy to locate.
• Compliance features located at appropriate points throughout most chapters offer tips to ensure compliance with correct billing and coding practice, particularly HIPAA and OIG.
• A separate chapter on documentation in the medical office describes how proper documentation can prevent penalties and refund requests, and help you prove compliance in the case of an audit or review.
• Detailed examples and samples of completed insurance forms show you how to apply knowledge in the real world.
• Emphasis on the business of running a medical office highlights the importance of the medical insurance specialist's role in filing clean claims, solving problems that do occur, and collecting overdue payments.
• Service to Patient feature throughout the chapters focuses on ways to provide quality service to the patient as well as your co-workers.

• All content has been reviewed by industry experts and meticulously updated to reflect recent changes in insurance claim filing.
• In addition to the list of key terms at the beginning of each chapter, a separate list of key abbreviations clarifies common terms identified in the field primarily by their abbreviations.
• Key points at the end of each chapter briefly summarize important chapter content to help you better understand the subject matter.

• 3 separate chapters offer coverage of the basic concepts of medical coding.
• A comprehensive overview of the CMS-1500 claim form with step-by-step guidelines and illustrations thoroughly covers reimbursement issues and explains the billing process.
• Includes detailed information on various insurance payers and plans including Medicare, government medical plans, disability plans, private indemnity plans, and managed care.
• Stop & Review sections illustrate how the concepts presented in each chapter relate to real-life billing situations.
• Sidebars and Examples highlight key concepts and information related to the core text lesson.
• A companion CD-ROM contains sample patient and insurance information that readers can use to practice completing the accompanying CMS-1500 claim form, as well as a demonstration of Altapoint practice management software.

• Features completely updated information that reflects the many changes in the insurance industry.
• Contains a new chapter on UB-92 insurance billing for hospitals and outpatient facilities.
• Includes a new appendix, Quick Guide to HIPAA for the Physician's Office, to provide a basic overview of the important HIPAA-related information necessary on the job.

The chapters’ organization follows the medical billing process to enhance learning, moving from a comprehensive introductory chapter through processing RA/EOBs and handling patient collections. Every chapter has extensive illustrations, forms, and exercises to develop the required competencies as well as exercises to improve underlying essential math and communications skills. This text also provides a fundamental understanding of diagnostic and procedural coding needed to submit claims in compliance with payers’ requirements. New for this edition is a text-specific workbook which provides both review and applications of each textbook chapter.

• Meticulously reviewed by a panel of industry experts.
• Emphasis on the business of running a medical office highlights the importance of the medical insurance specialist's role in filing clean claims, solving problems, and collecting overdue payments.
• Key terms are bolded at first mention, explained within the context of the discussion, and defined in the glossary.
• Key points summarize important chapter content.
• Block-by-block explanations and examples demonstrate the correct way to complete the CMS-1500 claim form.
• Completed sample insurance forms apply concepts to real life.
• Unique payer icons clarify CMS claim form completion.
• Form icons and Computer icons ease the transition from paper to electronic filing.
• Special HIPAA Alerts ensure compliance with governmental privacy regulations.
• Guidelines for the filing and submission of electronic claims include the do's and don'ts for the electronic environment.
• Service to Patient features discuss ways to provide quality service to the patient as well as to your co-workers.
• A documentation chapter covers the principles of documentation and shows how proper documentation can prevent penalties and refund requests, and help you prove compliance in the case of an audit or review.
• An Evolve website includes supplemental Medisoft activities, self-assessment quizzes, updates of content, and web links for further research and study.
• A workbook contains learning tips, review exercises, cases, and critical thinking activities for hands-on experience with real-world cases. (Available separately.)

• Updated learning objectives correlate directly to the text, making it easier to study and to measure your progress.
• New CMS-1500 form filler software on Evolve provides additional exercises for hands-on practice.

-Official CPT coding rules and guidelines - Necessary to interpret and report medical procedures and services

-Summary of additions, deletions, and revisions in Appendix B - Provides a quick reference to 2006 changes without having to refer to previous editions

-Place of Service codes with facility name and description - Used on professional claims to specify the entity where services are rendered

-Color bleed bars and thumb-notch tabs - Help you quickly locate code sections