Medical Insurance
A Revenue Cycle Process Approach
By: Joanne Valerius
"Follow the Money! Medical insurance plays an important role in the financial well-being of every healthcare business. The regulatory environment of medical insurance is now evolving faster than ever. Changes due to healthcare reform require medical office professionals to acquire and maintain an in-depth understanding of compliance, electronic health records, medical coding, and more. The eighth edition of Medical Insurance: A Revenue Cycle Process Approach emphasizes the revenue cycle steps that clearly identify all the components needed to successfully manage the medical insurance claims process. The cycle shows how administrative medical professionals "follow the money"--
AI Overview
The book "Medical Insurance: A Revenue Cycle Process Approach" by Joanne Valerius is a comprehensive textbook designed for students and professionals in the field of medical insurance and billing. Here is a detailed overview of the book:
Key Themes
- Revenue Cycle Process: The book emphasizes the revenue cycle, which is broken down into ten steps that clearly identify all the components needed to manage medical billing and insurance processes.
- Medical Billing Process: It covers the entire medical billing process from patient encounters to billing information, claim preparation, and payment processing.
- Claim Coding: The book includes detailed chapters on diagnostic coding (ICD-9-CM), procedural coding (CPT), and HCPCS (Healthcare Common Procedure Coding System).
- Payers and Payment Processing: It discusses various payers such as private payers, Medicare, Medicaid, Tricare, and Workers' Compensation, as well as payment processing, appeals, and secondary claims.
- Hospital Services: The book also covers hospital billing and reimbursement processes.
Plot Summary
The book is structured into several parts, each focusing on a specific aspect of the medical insurance and billing process:
- Part 1: Working with Medical Insurance and Billing covers the introduction to the medical billing process, HIPAA regulations, and patient encounters.
- Part 2: Claim Coding delves into diagnostic and procedural coding systems.
- Part 3: Claim Preparation focuses on visit charges, compliant billing, and healthcare claim preparation and transmission.
- Part 4: Payers discusses various types of payers and their specific requirements.
- Part 5: Payment Processing covers payments, appeals, and secondary claims.
- Part 6: Hospital Services addresses hospital billing and reimbursement.
- Part 7: Claim Case Studies provides practical applications of the concepts learned through case studies.
Critical Reception
While there is no specific critical reception available in the provided sources, the book is designed to provide students with the knowledge and skills needed to successfully perform insurance and billing-related duties. It is widely used in medical insurance courses and is considered a comprehensive resource in the field.
Edition Details
The book is available in various editions, with the fifth edition (Medical Insurance: An Integrated Claims Process Approach) being one of the most recent. It was published in January 2016 by McGraw-Hill Education and contains 605 pages.
In summary, "Medical Insurance: A Revenue Cycle Process Approach" by Joanne Valerius is a detailed and structured textbook that covers all aspects of the medical insurance and billing process. It is a valuable resource for students and professionals looking to understand and navigate the complexities of medical billing and insurance.