Coding for Hipaa: How to Report Professional Claims [Paperback]

Jean P. Narcisi (Author)

Book Description

Publication Date: March 2004

This resource takes readers from the paper-based world of health care claims and gives them the data content knowledge necessary for reporting claims in the HIPAA environment. It examines the CMS 1500 claim form in detail, gives a brief overview of the electronic transactions standards mandated by the secretary of the Department of Health and Human Services, and primarily addresses the non-medical code sets required under HIPAA, including place of service, claim adjustment reason, provider taxonomy, and remittance remark. This book provides a comprehensive education on particular elements not found in other HIPAA publications, particularly the reporting of the specialty of the practitioner providing the service using the appropriate provider taxonomy code on an electronic form. Insurance companies are requiring these codes more frequently.

Editorial Reviews

From the Back Cover

It is estimated that 500 million health claims are filed each month, yielding approximately 6 billion claims each year. Of all claims submitted, only 40 percent are filed electronically. The other 60 percent are still filed on a paper claim form called the CMS-1500.

According to the AMA survey on technology usage, 88 percent of physician practices submit at least some of their claims electronically. The percentage of physicians submitting claims electronically and the number of health plans able to receive them electronically will grow steadily in the next few years due to the implementation of the national electronic standards named in HIPAA>

Coding for HIPAA takes readers from the paper-based world of health care claims and gives them the data content knowledge necessary for reporting claims in the HIPAA environment. In clear language, this resource examines the CMS-1500 claim form in detail, gives a brief overview of the electronic transactions standards mandated by the US Department of Healthy and Human Services, and addresses the non-medical code sets required under HIPAA, which include:

-Provider Taxonomy - a standard administrative code set for identifying the provider type and area of specialization for all health care providers.

-Claim Adjustment Reason - a code set used to communicate why a claim or service line was "adjusted" (paid differently than was billed).

-Remittance Advice Remark - a code set that adds greater specificity to an adjustment reason code.

-Claim Status Category - a code set that indicates the general category of the status of a claim within the adjudication process (eg. accepted, rejected, additional information requested, etc).

-Claim Status - a code set that further communicates information about the status of a claim.

-Place-of-Service - a code set to specify the entity where service(s) are rendered.

Product Details

• Paperback: 350 pages
• Publisher: Amer Medical Assn; 1 edition (March 2004)
• Language: English
• ISBN-10: 1579475507
• ISBN-13: 978-1579475505
• Product Dimensions: 11 x 8.5 x 0.9 inches
• Shipping Weight: 2.2 pounds (View shipping rates and policies)
• Amazon Best Sellers Rank: #3,878,494 in Books (See Top 100 in Books)

More About the Author

Discover books, learn about writers, read author blogs, and more.