Hospital Billing From A To Z

Hospital Billing from A to Z Charlotte L. Kohler, RN, CPA, CVA, CRCE-I, CPC, ACS, CHBC With Kohler HealthCare Consulting, Inc., associates Catherine Clark, CPC, CRCE-I Darrin Cornwell, CRCS-I Janet Ellis, RN, BSN, MS Dawn Doll Homer, CPC, CRCS-I, CDC Daria Malan, RN, LNHA, MBA, RAC-CT(R) John Ninos, MS, MT(ASCP), CCS Robin Stover, RN, BSBA, CPC, CPC-H, CMAS Deanna Turner, MBA, CPOC, CPC, CPC-I, CSSGB Susan Walberg, JD, MPA, CHC Hospital billing departments are known by various names, but their staff all experience the same problems understanding and complying with Medicare's many billing requirements. Hospital Billing From A to Z is a comprehensive, user-friendly guide to hospital billing requirements, with particular emphasis on Medicare. This valuable resource will help hospital billers understand how compliance, external audits, and cost-cutting initiatives affect the billing process. Beginning with Advance Beneficiary Notice and ending with Zone Program Integrity Contractors, this book addresses 88 topics in alphabetical order, including the following: 2-Midnight Rule and Inpatient Admission Criteria Correct Coding Initiative CPT(R), HCPCS, Condition Codes, Occurrence Codes, Occurrence Span Codes, Revenue Codes, and Value Codes Critical Access Hospitals Deductibles, Copayments, and Coinsurance Denials, Appeals, and Reconsideration Requirements Dialysis and DME Billing in Hospitals Hospital-Issued Notice of Noncoverage Laboratory Billing and Fee Schedule Local and National Coverage Determinations Medically Unlikely Edits and Outpatient Code Editor Medicare Advantage Plans Medicare Beneficiary Numbers and National Provider Identifier Medicare Part A and Part B No-Pay Claims Observation Services Outlier Payments Present on Admission Rejected and Returned Claims UB-04 Form Definitions Who should read this book? Finance and reimbursement staff Chargemaster staff Billers and coders HIM staff Clinical department staff Revenue managers Compliance officers and auditors Registration staff Fiscal intermediary staff Healthcare attorneys, consultants, and CPAs Legal department staff

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 first textbook that helps HIM professionals and students understand the differences between the UB-04 and the UB-92 and provides a global view of how the billing function should work in conjunction with the coding department. The Handbook provides accurate and timely information about the UB-04 and explains how and why ICD-9, CPT and HCPCS code conventions must be integrated with UB-04, HCFA-1450 and CMS-1450 billing conventions. The book teaches an individual how to complete a facility UB-04 billing form, and contains vignettes that explain the billing office process, its components and reporting nuances. It will help HIM staff understand that coding conventions for billing are as important as ICD-9 coding conventions when sending a claim to an insurance company or payer and ensure that members of other departments (e.g., accounting, admitting, quality management) understand how their indispensable contributions to the revenue cycle must be translated by billers to fit changing UB-04 Form Locator codes.The book contains an overview of basic payment methodologies, plus 65 quizzes that can be used for self-testing, for performance evaluations or classwork assignments. This book will help hospitals and other health care providers maximize claim processing performance and revenue recovery and better manage their revenue cycle process.

Hospital Billing, Second Edition provides current content with a practical approach. The content addresses the real world of the hospital billing department, integrating the computer skills and procedures needed for daily work. The material also addresses the types of critical thinking, analysis, and synthesis skills demanded by today’s employers. The text includes instruction that entry-level hospital billers must understand, including the following: the hospital billing flow; basic coding and payment systems; the data elements required to complete the recently mandated new UB-04 form; the way in which form-completion requirements vary depending on the type of facility; the medical insurance plan, and inpatient/outpatient status; job performance in compliance with HIPAA privacy and best practices regulations; and how computerized systems are used for form completion