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• Cover
• Introduction
• About This Book
• Foolish Assumptions
• Icons Used in This Book
• Beyond the Book
• Where to Go from Here
• Part 1: Getting to Know Medical Billing and Coding
• Chapter 1: Dipping Your Toes into Medical Billing and Coding
• Coding versus Billing: They Really Are Two Jobs
• Following a Day in the Life of a Claim
• Keeping Abreast of What Every Biller/Coder Needs to Know
• Deciding Which Job Is Right for You
• Prepping for Your Career: Training Programs and Certifications
• Planning for the Future
• Chapter 2: Exploring the Billing and Coding Professions
• Looking at the Medical Coding Job
• Breaking Down the Medical Biller’s Job
• In Tandem: Working Together or Doing Both Jobs Yourself?
• Chapter 3: Weighing Your Employment Options
• Choosing Your Environment: Doctor’s Office, Hospital, and Others
• Remote Access: Setting up Off-Site
• Reviewing Other Work Options: Freelancing, Temping, and More
• Heeding a Word of Advice for New Coders
• Part 2: Boning Up on the Need-to-Knows of Your Profession
• Chapter 4: Compliance: Understanding the Rules
• You Rule! Meeting the Rule Makers
• Complying with HIPAA
• Unbundling the Compliance Bundle
• Getting the Most out of the Dreaded Audit
• Chapter 5: Not-So-Strange Bedfellows: Medical Terminology and Medical Necessity
• Brushing Up on Basic Anatomy
• Say What? Deciphering Medical Terminology
• Understanding Medical Necessity
• Scrubbing In: Proving Medical Necessity for Surgical Procedures
• Connecting with the World of Evaluation and Management Codes
• Chapter 6: Getting to Know the Payers
• Wading through Commercial Insurance Payers
• Medicare: Meeting the Chief Government Payer
• Working with Other Government Payers
• Part 3: Becoming a Professional: Getting Certified
• Chapter 7: Your Basic Certification Options, Courtesy of the AAPC and AHIMA
• Introducing the Two Main Credentialing Organizations: AAPC and AHIMA
• Looking at the Basic Certifications
• Choosing the Certification That’s Right for You
• Examining the Exams: A Quick Review of the Main Tests
• Chapter 8: The Path to Certification: Finding a Study Program
• The Big Picture: Thinking about Your Degree and Career Objectives
• Considering the Time Commitment
• First Things First: Squaring Away Your Prerequisites
• Picking a Program of Study
• Caveat Emptor: Watching Out for Diploma Mills
• Chapter 9: Signing Up and Preparing for the Certification Exam
• Establishing a Study Routine and Strategy
• Focusing on the Right Topics
• Preparing Yourself for Test Day
• Signing Up for and Taking the Big Test
• Chapter 10: Adding Street Cred: Specialty Certifications and Continuing Ed
• Introducing Specialty Certification Options
• Building on Your Cred with Continuing Education
• Part 4: Dealing and Succeeding with Nitty-Gritty On-the-Job Details
• Chapter 11: Processing a Run-of-the-Mill Claim: An Overview
• Dreaming of the Perfect Billing Scenario
• Delving into the Details: Contract Specifics
• Covering Your Bases: Referrals and Preauthorization
• Tracking Your Claim from Submission to Payment
• Fighting for Proper Payment: Filing an Appeal with the Payer
• Chapter 12: Homing In on How to Prepare an Error-Free Claim
• Assigning CPT Codes
• Applying Modifiers Correctly
• Looking for Money Left on the Table
• Checking and Double-Checking Your Documentation
• Chapter 13: From Clearinghouse to Accounts Receivable to Money in the Pocket
• Spending Time in the Clearinghouse
• Facing Factors Affecting Reimbursement Amounts
• Payment or Denial: Being in the Hands of the Payer
• Breaking Down the Remittance Advice
• Chapter 14: Handling Disputes and Appeals
• Dealing with Disputes Involving Contract and Non-Contracted Payers
• Knowing When to File an Appeal: General Guidelines
• The Art of the Appeal: Understanding the Basics before You Begin
• Going through an Appeal, Step by Step
• Appealing Medicare Processing
• Appealing a Workers’ Comp Claim
• Chapter 15: Keeping Up with the Rest of the World
• WHO’s on First: Providing Data to the World Health Organization
• Charting Your Course with ICD
• Moving beyond ICD-10
• Part 5: Working with Stakeholders
• Chapter 16: Dealing with Commercial Insurance Claims
• Meeting Commercial Insurance
• Cashing In with Commercial Payers
• Knowing What’s What: Verifying the Patient’s Plan and Coverage
• Chapter 17: Caring about Medicare and Medicaid
• Brushing Up on Medicare Basics
• Working with Medicare Claims
• Deciding What Gets Paid
• Working with Medicare Contractors
• Doing Business with Medicare Part C Plans
• Verifying Coverage and Plan Requirements
• Chapter 18: Coding Ethics: Being an Advocate for Your Employer
• Playing the Part of the Professional Medical Biller/Coder
• Protecting Yourself and Your Integrity
• Getting the Most Bang for Your Client’s Buck — Honestly
• Part 6: The Part of Tens
• Chapter 19: Ten Common Billing and Coding Mistakes and How to Avoid Them
• Being Dishonest
• Shifting the Blame
• Billing More than Is Documented
• Unbundling Incorrectly
• Ignoring an Error
• Mishandling an Overpayment
• Failing to Protect Patients from Out-of-Network Penalties
• Failing to Verify Prior Authorization
• Breaking Patient Confidentiality
• Following the Lead of an Unscrupulous Manager
• Chapter 20: Ten Acronyms to Burn into Your Brain
• ACA: Patient Protection and Affordable Care Act
• ACO: Accountable Care Organization
• CDI: Clinical Documentation Improvement
• CMS: Centers for Medicare & Medicaid Services
• EHR: Electronic Health Record
• EOB: Explanation of Benefits
• HIPAA: Health Insurance Portability and Accountability Act
• INN: In-Network
• NCCI: National Correct Coding Initiative
• OON: Out-of-Network
• Chapter 21: Ten (Plus One) Tips from Billing and Coding Pros
• Insist on Proper Documentation
• Verify Patient Benefits
• Get Vital Patient Info at Check-In
• Review the Documentation ASAP
• Set Up a System to Ensure Accuracy
• Play Nice with Others
• Follow Up on Accounts Receivable Daily
• Be a Bulldog on the Phone
• Know Your Payer Contracts by Heart
• Create a File System That Lets You Find What You Need
• Make Payers Show You the Money!
• Glossary
• Index
• About the Author
• Connect with Dummies
• End User License Agreement