Collect money owed to your practice. Improve your revenue cycle by maximizing key processes for professional fee billing. Written by industry experts, this book is a step-by-step guide to billing and collection processes, performance outcomes and advanced billing practices. It includes case studies, tools, checklists, resources, policies and procedures to help you diagnose problems and develop plans to attain optimal financial performance.

Full of new, innovative tools, techniques, policies and procedures, and advanced practices that allow you to diagnose and treat your revenue cycle and ensure a financially healthy bottom line. The depth and magnitude of change in health care reimbursement means that your medical practice cannot rely on the same old billing methods. Anything less than optimal performance from your billing office reduces cash flow and costs you money. The authors present cutting edge strategies to meet today s reimbursement challenges and improve the profitability of your medical practice. The authors lay out real life business practices that can be adopted tomorrow in your medical practice, including how to: Decipher consumer-directed health plans; Conduct patient financial clearance; Segment patients in terms of financial risk; Staff to effectively conduct front-end and back-end billing; Capture increased revenue at the point of care; Understand real-time claims adjudication; Shrink your collections cycle; Position your practice for pay-for-performance; Work and prevent costly claim denials and rework; Code appropriately to ensure your fair share of differential payer reimbursement; Leverage multiple technologies; and Perform a cost/benefit analysis of your revenue cycle.

This third edition of the MGMA bestseller on physician billing process and revenue cycle management is a completely revised, comprehensive manual. Delivering proven solutions to optimize your revenue cycle, this professional fee billing primer is business-critical whether you're new to managing the revenue cycle or a seasoned professional.

Revised in 2016! This no nonsense book tells you all you need to know to understand medical billing. Written by a mother/daughter team who have been running a medical billing service since 1994 it contains the facts without the fluff. Revised in June 2010 to almost double the content. It contains information about primary, secondary and tertiary claims, participation with insurance carriers, indemnity, hmos, ppos, eops, Medicare, Medicaid, Medicare hmos, workers comp, no fault, NPI numbers, copays, coinsurance, deductibles, patient billing, fraud, HIPAA, audits, overpayments and much more. A must read for every member of the staff in the doctor's office. Whether you need to improve office efficiency, improve the cash flow, or just understand the medical billing process better, this book is for you.

Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician's office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS. While the medical coder and medical biller may be the same person or may work closely together to make sure all invoices are paid properly, the medical coder is primarily responsible for abstracting and assigning the appropriate coding on the claims. In order to accomplish this, the coder checks a variety of sources within the patient's medical record, (i.e. the transcription of the doctor's notes, ordered laboratory tests, requested imaging studies and other sources) to verify the work that was done. Then the coder must assign CPT codes, ICD-9 codes and HCPCS codes to both report the procedures that were performed and to provide the medical biller with the information necessary to process a claim for reimbursement by the appropriate insurance agency. This text is intended to dispel any ambiguity prior to taking your national certification. This text contains over 400 preparatory examination questions, covering ICD-9, ICD-10, Revenue cycle, Medical report extrapolation assignments, HCPCS, UB04, and CPT.

From Patient to Payment: Insurance Procedures for the Medical Office, provides a practical, focused overview of medical insurance and billing. Each chapter is structured to give students a hands-on, practical approach to understanding and working with claims, both paper and electronic, and the medical billing process. This text is precisely tailored for a brief introduction, as the fundamental understanding of coding and claim filing principles is the goal. Incorporated are the latest HIPAA forms and regulations, medical coding, and electronic claims in a clear and focused program. It equips students with the basics of preparing correct health care claims, and provides a brief introduction to Medisoft Patient Billing software V14 , which can be used to complete claims.

A basic guide to hospital billing and reimbursement, Understanding Hospital Billing and Coding, 3rd Edition helps you understand, complete, and submit the UB-04 claim form that is used for all Medicare and privately insured patients. It describes how hospitals are reimbursed for patient care and services, showing how the UB-04 claim form reflects the flow of patient data from the time of admission to the time of discharge. Written by coding expert Debra P. Ferenc, this book also ensures that you understand the essentials of ICD-10-CM and develop skills in both inpatient coding and outpatient/ambulatory surgery coding. UB-04 Claim Simulation on the companion Evolve website lets you practice entering information from source documents into the claim form. Over 300 illustrations and graphics bring important concepts to life. Detailed chapter objectives highlight what you are expected to learn. Key terms, acronyms, and abbreviations with definitions are included in each chapter. Concept Review boxes reinforce key concepts. Test Your Knowledge exercises reinforce lessons as you progress through the material. Chapter summaries review key concepts. Practice hospital cases let you apply concepts to real-life scenarios. UPDATED content reflects the most current industry changes in ICD-10, MR-DRGs, PPS Systems, and the Electronic Health Record. NEW Hospital Introduction chapter includes a department-by-department overview showing how today’s hospitals really work NEW Health Care Payers and Reimbursement section follows the workflow of the hospital claim by including successive chapters on payers, prospect payment systems, and accounts receivable management.

The essential guide for medical billing professionals, updated for ICD-11 standards Medical Billing & Coding For Dummies will set you up for success in getting started as a medical biller and coder. To ensure data accuracy and efficient data processing, medical offices need professionally trained coders to handle records. This book provides prospective allied health professionals with everything they need to know to get started in medical billing and coding as a career. In addition to an introduction to the basics of medical coding, you'll get information on how to find a training course, meet certification requirements, and deal with government agencies and insurance companies. Learn about the standard practices in the medical billing industry and get up to speed on the ethical and legal issues you're likely to face on the job. This accessible guide is a great entry point—and a great refresher—for anyone interested in the medical billing and coding profession. Get a primer on your career options in the field of medical billing Learn coding practices for telehealth, viral outbreaks, and other emerging issues Update your knowledge of the changes between ICD-10 and ICD-11 coding systems Find training programs and explore your options for certification This Dummies guide is an accessible entry point for prospective professionals looking get a jump on their new career, and current professionals intent on staying up-to-date in this flexible and growing field.

Anecdotes and real case studies ripped from the headlines about what doctors did which got them into trouble either with Medicare, HIPAA, The Office of Inspector General (OIG) or worse the FBI. The case studies are true stories of medical professionals: Some are about providers just like you trying to navigate the complex maze of the medical billing process. This guide will help you recognize the red flags and triggers so you can avoid a Medicare Audit. Learn about common problems that plague medical practices. Discover what your peers have done right and what they have done wrong. Avoid the costly billing mistakes and practice mismanagement showcased in Medical Billing Horror Stories. With the changes, challenges and uncertainties facing the Healthcare industry you cant afford to miss this information. If you submit even one claim for reimbursement this is a must read!

The definitive guide to starting a successful career in medical billing and coding With the healthcare sector growing at breakneck speed—it’s currently the largest employment sector in the U.S. and expanding fast—medical billing and coding specialists are more essential than ever. These critical experts, also known as medical records and health information technicians, keep systems working smoothly by ensuring patient billing and insurance data are accurately and efficiently administered. This updated edition provides everything you need to begin—and then excel in—your chosen career. From finding the right study course and the latest certification requirements to industry standard practices and insider tips for dealing with government agencies and insurance companies, Medical Billing & Coding For Dummies has you completely covered. Find out about the flexible employment options available and how to qualify Understand the latest updates to the ICD-10 Get familiar with ethical and legal issues Discover ways to stay competitive and get ahead The prognosis is good—get this book today and set yourself up with the perfect prescription for a bright, secure, and financially healthy future!