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Statistics published by the U. S. Department of Commerce (1980) indicate that in 1977 we spent 8. 1% of our gross national product (GNP) on life, health, property-casualty, and other forms of insurance. An additional 5. 7% was used to pay the Social Security tax, which is another form of insurance premium, for a total of 14. 8% of the GNP. Although insurance had its historical origin in marine insurance, it has now developed into one of the major industries of the American economy and extends into many areas of economic activity. One area where growth has been particularly strong is the medical sector. Health insurance is a major institution in all industrialized countries. It became a government responsibility in 1883 when Bismarck intro- duced a compulsory program of health insurance for industrial workers in Germany. Programs for workers in various industrial and income categories soon followed in other European countries-Austria (1888), Hungary (1891), Norway (1909), Servia (1910), Great Britain (1911), and Russia and Romania (1912) (Rubinow, 1913:250). Programs in these countries were extended in subsequent years, and other countries in Europe followed with their own programs. Consequently, today most industrial countries have universal or near-universal health insurance coverage. In the United States the issue of national health insurance has been seriously debated since just prior to World War I, and polling data since the 1930s show that a substantial majority of the public has been supportive of such a program (Erskine, 1975).
Understanding Health Insurance: A Guide to Billing and Reimbursement, 8th Edition is a comprehensive source for teaching the subject of health insurance and reimbursement. The book contains chapters on introductory information on the health insurance field, managed health care, legal and regulatory issues, coding systems, reimbursement methodologies, coding for medical necessity, and common health insurance plans. Each chapter contains exercises to illustrate content and reinforce learning. Numerous opportunities are provided throughout the book for manual completion of CMS-1500 claims. A CD-ROM at the back of the book allows for electronic data entry of CMS-1500 claim form information. End of chapter review questions in objective format (e.g., multiple choice) test learners on their understanding of book content. Appendices I and II provide case studies that are also included on the Student Practice CD-ROM. Additional appendices provide instruction in dental claims processing and completion of the UB-92 (claim used for inpatient and outpatient hospital claims). The accompanying workbook provides application based assignments for each chapter, additional content review (multiple choice questions), and additional case studies for practice in completing CMS-1500 claims. This edition of the book contains the most up to date information regarding health insurance claims processing and coding and reimbursement issues.
Discover the essential tool to prepare for a career in medical insurance billing -- UNDERSTANDING HEALTH INSURANCE, 13E. This comprehensive, easy-to-understand, updated book presents the latest code sets and guidelines. You cover today's most important topics, such as managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. Updates introduce new legislation that impacts health care, including the Affordable Care Act (Obamacare); ICD-10-CM coding; electronic health records; Medicaid Integrity Contractors; case mix management; hospital-acquired conditions; present on admission; and value-based purchasing. Practice exercises and the workbook (available separately) provides application-based assignments and case studies to reinforce your understanding, as well as CMRS, CPC-P, and CPB Mock Exams. New editions include online access to SimClaim CMS-1500 claims completion software and Optum's EncoderPro.com Expert.
Bioethics and Public Health Law is based on Part II--The Patient, the Provider, and the State, of parent book Health Care Law and Ethics, and adds additional coverage a variety of issues and topics not covered in the parent book. Integrating public health, financial and ethical issues, this casebook uses compelling case law, clear notes, compelling problems and comprehensive background information to illuminate the complex and dynamic field of bioethics and public health care law.
The Third Edition includes recent cases and developments in biotech, including stem cell research and gene patents, and has been updated for HIPPA coverage, DNA research and biobanks. Discussions of confidentiality and informed consent include new legislative and judicial responses to posthumous reproduction and the challenges arising from international reproductive tourism.
Thoroughly updated, the revised Third Edition includes:
The idea for this book came from my decision to update an article by Roy C. McCullough entitled "Insurance Rates in the Courts" published in the June and July 1961 issues of the Insurance Law Journal. When this project began, the intention was to produce a similar journal article surveying insurance rate litigaÂ tion between 1960 and the present using basically the same organization followed in the seminal article. However, the volume of reported cases during the last twenty years was much larger than anticipated and the issues being litigated had expanded dramatically. The project grew as my study progressed, and the resulting book surveys more than three hundred disputes involving insurance ratemaking and insurance rate regulation. The fruition of this project would not have been possible without the consistent encouragement and criticism of Roy McCullough, and it is with gratitude that I acknowledge his continuous and valuable assistance to me in this effort. Once an initial draft was prepared, a number of my associates cooperated by reading and commenting on the manuscript. I would like to give special thanks to Michael J. Miller and James F. Perry who unselfishly shared their time and knowledge to improve this work. Needless to say, none of those who read the manuscript is responsible for any errors in concept or detail that may remain.