comprehensive health insurance billing, coding, and reimbursement copyright ©2009 by pearson...
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Comprehensive Health Insurance
Billing, Coding, and Reimbursement
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Chapter 1Introduction to Professional Billing and Coding Careers
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Introduction to Billing and
Coding Careers Many opportunities can be found for the
professional healthcare reimbursement specialist.
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Facilities
Physician's practice Solo practice: Single physician Small group practice: 2-3 physicians Large group practice: 4-5 or more
physicians
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Hospitals
Patient account services facility (PAS) Centralized billing office (CBO)
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Job Titles and Responsibilities
Medical Office Assistants- may also be known as an administrative medical assistant, secretary or medical receptionist. – Usually work in physician's offices and are
considered front office staff administrative duties
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Job Titles and Responsibilities
Medical Billers- handle submission of insurance claims, data entry, and contacting insurance companies regarding incorrectly paid claims
Medical Coders- conduct research and reference check of medical records and are responsible for accurate coding of the primary/secondary diagnoses and procedures
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Job Titles and Responsibilities
Registered Health Information Technician- may also be referenced as coder, file clerk, health information clerk, medical records director, medical records technician or office manager– Compiles, processes, and maintains medical
records
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Job Titles and Responsibilities
Payment Poster - generally reads the Explanation of Benefits documents issued by insurance carriers and posts the payments or contractual adjustments to the appropriate patient account
Medical Collector- contacts patients and insurance carriers to collect money owed to the medical facility
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Job Titles and Responsibilities
Refund Specialist - analyzes patient accounts to discern whether or not a refund is required, and if so, to whom the money should be returned
Insurance Verification Representative- contacts insurance carriers to verify benefit information for patients. May also perform precertification and/or prior authorization of service duties.
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Job Titles and Responsibilities
Admitting Clerk- responsible for registering and greeting patients, having patients complete paperwork, answering questions, data entry of patient demographic and insurance information, and requesting information and payment
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Job Titles and Responsibilities
Patient Information Clerk- responsible for answering questions about and explaining HIPAA privacy regulations, living wills, DNR orders, and other information to patients and their family members
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Reasons for Obtaining Certification
Stay current in your field. Excellent addition to your resume Professional journals/newsletters Networking
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Organizations that Offer Certification to the
Medical Office Specialist American Health Information Management
Association (AHIMA) American Academy of Professional Coders
(CCPC) National Center for Competency Testing
(NCCT) National Healthcareer Association (NHA)
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Certifications
Medical office assistant certification– National Certified Medical Office Assistant– Certified Medical Administrative Assistant
Medical billing certifications Certified Medical Billing Specialist
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes
Certifications
Medical coding certifications– Certified Coding Associate– Certified Professional Coder– Certified Professional Coder- Hospital– Certified Coding Specialist– Certified Coding Specialist- Physician
Medical records certification– Registered Health Information Technician