A comprehensive guide designed to help consumers understand the American health insurance system so that they can obtain the benefits to which they are entitled. Epstein explains the ins and outs of both new and traditional health insurance plans, including traditional individual and group policies, HMOs and other types of managed care plans, self-funded plans, Medicare, Medicare HMOs, Medigap, long-term care, COBRA, CHAMPUS, and Medical Savings Accounts.
Written by a nationally syndicated columnist, this useful volume also deals with special health insurance issues related to children, adults with special needs, and individuals who may need long-term care. In addition, Epstein provides valuable information for individuals who are in the process of changing jobs or making changes in their marital or family status, choosing a health insurance plan, or arranging long-term care-including placement in a nursing home or an assisted-living facility-for an aging parent. The book has a practical focus with a variety of tables and worksheets to help consumers establish a system for preventing health insurance problems, and for dealing with any health insurance problems that may arise. It also contains answers to common questions about health insurance, and provides a list of organizations that offer detailed information and advice in regard to specific health insurance problems.
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.
Mental health policy in the United States has involved varying approaches, often reflecting the social and economic conditions of the times. The compelling needs of individuals, however, have consistently demanded attention and some form of public policy response has been necessary, even since the early days. Societal reaction has moved in many differing directions--from institutionalization and deinstitutionalization to the care and costs borne at public expense to the current emphasis on increasing privatization. Dorwart and Epstein stress that the mental health system must be seen as a system within two other systems--health care and social service--if it is to be effective. They have written an authoritative, comprehensive, and practical analysis of the mental health policy area, offering sound policy recommendations.
This book discusses legal issues related to the principle of indemnity in marine insurance contracts as well as disputes that may arise in a representative sample of common and continental law jurisdictions. It offers a comparative examination of Australian, English, Canadian, French, Greek, Norwegian and U.S. law. It examines the scope for a legal reform and the potential of achieving a better, more flexible, and modern indemnification regime.