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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.
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.
A condensed version of the classic Fundamentals of Risk and Insurance, this accessible text contains the latest forms, statutes and court decisions and examines specific contracts in detail to emphasize insurance principles. Addresses such timely issues as the high cost of medical care and automobile insurance. detail to emphasize insurance principles. The helpful study aids and the critical essentials of risk management and insurance remain intact. A special section on buying insurance prepares the reader for future purchases.
There are ways to tell if a man is a rogue:
Within all large consumer facing organizations, most decisions about how to deal with people are made automatically by computerized decision making systems. Information about people, their lifestyle and past behavior are used to predict how they are expected to behave in the future. It can be determined if someone applying for a bank loan will make their repayments, who will respond to a marketing communication and the likelihood that someone will claim on their insurance policy. This book provides a step-by-step guide to how Predictive Analytics is used by some of the world's most influential organizations. This includes international banks, leading insurance providers, credit reference agencies and national governments. It covers all stages of the Predictive Analytics process. This includes project management, data collection, sampling, data transformation and pre-processing, model construction, validation, implementation and post-implementation monitoring of the model's performance.