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Tables of Contents for Reimbursement Manual for the Medical Office
Chapter/Section Title
Page #
Page Count
Foreword & Acknowledgments
iii
Disclaimer
iv
The Author
v
Introduction and Overview
1
8
Key Points Regarding Reimbursement Management
1
1
Tools For The Business of Medicine
2
1
Basic Steps Of Medical Billing
2
4
Forms and Documents
6
1
Reference Materials
6
1
Policies and Procedures
7
1
Systems Development and Design Sequence
8
1
The Ultimate Goal
8
1
Terminology
9
18
Important Forms and Documents
27
20
Overview of Important Forms and Documents
27
2
Key Points Regarding Forms and Documents
29
1
Patient Registration Form
30
2
Release & Assignment Form
32
2
Preauthorization Form
34
2
Precertification Form
36
2
Superbill
38
2
Insurance Claim Form
40
2
Medicare Surgical Financial Disclosure Form
42
2
Medicare Medical Necessity Form
44
3
Procedure Coding with CPT & HCPCS
47
142
An Introduction To CPT and HCPCS Coding
47
1
Key Points Regarding CPT and HCPCS
48
1
Preparing for CPT and HCPCS Coding
49
2
Structure of CPT and HCPCS
51
3
How to Use CPT and HCPCS
54
4
How to Use HCPCS
58
2
General Coding and Billing Issues
60
24
Evaluation and Management Services
84
64
Anesthesia Services
148
4
Surgery Services
152
14
Radiology Services
166
4
Laboratory Services
170
2
Medicine Services
172
17
CPT Anatomical Illustrations
189
50
Diagnosis Coding with ICD-9-CM
239
40
Key Points Regarding ICD-9-CM
239
1
Preparing Your Practice for ICD-9-CM Coding
240
2
Medicare Requirements for ICD-9-CM Coding
242
2
Completing the HCFA 1500 Claim Form
244
1
Penalties for Non-Compliance
245
1
Historical Perspective
245
1
Important Coding and Billing Issues
246
2
Format of ICD-9-CM
248
3
ICD-9-CM Coding Conventions
251
2
Essentials of ICD-9-CM Coding
253
23
Using V-Codes
276
1
Using E-Codes
277
1
ICD-10
278
1
ICD-9-CM Anatomical Illustrations
279
50
Fee Schedule Review and Management
329
28
Key Points Regarding Setting Fees
329
1
Traditional Methods of Adjusting Fees
330
2
Prospective Reimbursement Systems
332
2
Fee Schedule Review and Management
334
3
Determining Fees for New Procedures
337
2
Medicare Participation Rates
339
3
Multiple Fee Schedules
342
1
The New Medicare Fee Schedule
343
3
Implementing Your Revised Fee Schedule
346
3
Strategic Pricing
349
2
Analyzing the Financial Health of Your Practice
351
2
Options to Increasing Your Fees
353
4
Designing a Better Superbill
357
20
Key Points Regarding Superbills
357
1
The Fundamentals of Good Superbill Design
358
2
Procedures
360
5
Quick Codes
365
1
Diagnosis Codes and Descriptions
366
1
Linking Diagnosis to Procedures
367
1
Other Information
368
1
Format and Design Issues
369
3
Sample Superbills
372
5
Dealing with Insurance Carriers
377
42
Key Points Regarding Health Insurance
378
1
Who's Who in Health Insurance
378
2
Major Types of Health Insurance Carriers
380
3
Understanding Health Insurance Coverage
383
3
Medicare As Secondary Payer (MSP)
386
2
Understanding Your Provider Profile
388
1
How Health Insurance Carriers Pay
389
2
Determining Eligibility and Verifying Benefits
391
1
Precertification and Predetermination
392
2
Should You Submit Claim Forms for Your Patients
394
1
How to Complete Health insurance Claim Forms
394
1
HCFA 1500 (12/90 Version)
395
10
Electronic (Paperless) Claims
405
4
Why Health insurance Claims are Rejected
409
1
Medicare Transaction System
410
1
Health insurance Claims Management
411
2
How to Get Paid Better and Faster
413
4
Medicare Fraud and Abuse
417
2
Managed Care
419
32
Managed Care is Here to Stay
420
1
Managed Care Organizations
421
5
The Future
426
2
Reimbursement Methods
428
16
Evaluating Managed Care Plans
444
6
How Many Managed Care Contracts Should You Sign
450
1
Index
451