Understanding Health Insurance

"Understanding Health Insurance: A Guide to Billing and Reimbursement" by Michelle Green is a comprehensive resource designed to equip readers with the necessary skills and knowledge for a career in medical insurance billing. Here is a detailed overview of the book:

Key Themes

1. Medical Coding Systems:

   • The book covers the assignment of ICD-10-CM, HCPCS Level II, and CPT codes, which are essential for accurate billing and reimbursement in the healthcare industry.

2. Health Insurance Claims:

   • It provides practical guidance on completing health insurance claims, including the use of the CMS-1500 claim form.

3. Revenue Management and Reimbursement:

   • The book delves into revenue management and reimbursement concepts, helping readers understand how to maximize financial returns from healthcare services.

4. Managed Care and Legal/Regulatory Matters:

   • It covers key areas such as managed care, legal and regulatory issues, and common health insurance plans, ensuring readers are well-informed about the broader context of health insurance.

5. Interactive Learning Tools:

   • The book includes MindTap online courseware, which offers an interactive simulation for completing CMS-1500 claims and assigning medical codes, enhancing the learning experience.

Plot Summary

The book is structured to provide a step-by-step guide to understanding health insurance, focusing on the practical aspects of billing and reimbursement. It starts with an introduction to the basics of health insurance, then moves on to detailed explanations of medical coding systems, claim submission processes, and revenue management strategies. The text is designed to be reader-friendly, making it accessible to both beginners and those looking to refresh their knowledge.

Critical Reception

While there is limited critical reception available, one review on Goodreads notes some practical issues with the physical book, such as the thinness of the paper, which can make it difficult to handle and use. However, this review does not provide a comprehensive critique of the book's content or its effectiveness in teaching health insurance billing and reimbursement.

Editions and Availability

The book is available in various editions:

• 2023 Edition (18th Edition): Published by Cengage Learning, this edition is available for $50.99 USD and includes built-in study tools, read-aloud functionality, offline access, and global search capabilities.
• 2024 Edition: Available for rent at $210.17, this edition is published by a different publisher and has an ISBN13 of 9780357932063.
• 2025 Edition: This edition is specifically mentioned in the context of enhancing skills and establishing a strong foundation for success in health insurance billing and reimbursement, but its availability and pricing details are not specified.

In summary, "Understanding Health Insurance: A Guide to Billing and Reimbursement" by Michelle Green is a comprehensive resource that provides essential knowledge and practical tools for those seeking to understand and navigate the complexities of health insurance billing and reimbursement.