Customer Reviews

Medical Billing & Coding Demystified

5 star:		(2)
4 star:		(4)
3 star:		(1)
2 star:		(4)
1 star:		(1)

 

 

Perahaps 30 pages of the book have anything to do with medical billing or coding. The rest of the book presents a summary of everything from telephone etiquette to the duties of the office manager. This is really more of a sloppily written introduction to running the front end of a medical practice than it is a serious introduction to medical billing and coding. As such the book is really only of value to someone thinking of pursuing a job in medical practice management and just wants to get an idea of what it's all about. It's of little value for anyone actually trying to figure out how medical billing and coding actually works.

"Medical Billing and Coding Demystified" provides a very high-level introduction to the namesake industry. I was disappointed that the first 80 pages of the book provide no information about billing nor coding, opting rather to provide a background of the entire healthcare industry that, as a whole, is only useful to the reader if he/she has never been to a doctor in the United States. Given that the book has fewer than 200 pages of informative text, I argue that the book is fundamentally mis-titled.

The book is also poorly edited, missing various commas and hyphens that would enhance readability, not to mention the authors' collective credibility. In one instance, the word "loose" is used where the word "lose" is the intention. These types of errors may seem trivial, but I prefer that my professional refrences be more polished than this one appears to be.

I have to agree with other reviewers who said this book was poorly edited. How this work could get past the proofreaders is beyond me! Perhaps they were in a hurry to get it published....That said, I did find this book very useful as I am considering a career in this area and really knew very little about what I'd be getting myself into. If you know a lot about the field already but want some detailed instruction on how to do coding, this book is NOT for you. After reading it, I have only a general idea of how it's done but couldn't code the common cold to save my life! However, if you're wondering what a medical biller and coder does, why this type of work is essential, and how the biller/coder fits into the big picture with insurance companies, healthcare providers, and patients, then I'd recommend this book. Even with my frustrations with all the errors, I still do not regret purchasing this book.

I'll admit I was turned off in the first few pages of the book with a section that characterized medical insurance as a "game" and all-but accused medical insurers of deliberately delaying claims payment in order to make money, using an example that doesn't make any fiscal sense anyway.

Clearly, the authors have the "insurance is big business screwing the little people" agenda. Thus this book is not useful to anyone actually looking for a balanced or in-depth view of the medical reimbursement industry.

But for someone who's looking for a general introduction to medical office practice as seen from the eyes of the "little man" doctor, this is not a bad first choice. The roles of the various players in the office are correctly explained except for the frequent incorrect use of "medical insurance specialist." Clearly, the book is intended to build up those who feel that billing clerks are at the bottom of the office pecking order -- and that's not necessarily a bad thing either.

Anyone who thinks, however, that the book's little coding exam is actually all there is to coding is badly mistaken. The book also has a considerable paucity of information for those wanting to take the next steps.

I can't recommend it.

This book was disappointing for a college level reference. Perhaps better as a basic introduction, but not demystifying as promised.

This book is not a good book for medical billing start ups. I realize the book is tarageted to medical insurance specialist. I find the book replete with too much theory. I do not recommend this book for those interested in starting a medical billing practice or learning more about medical billing.

I have worked with collections for 15 years.
After reading this book I have a complete understanding of the billing proccess from start to finsh. Also very good information on how the doctor's office's work. In clear english. Thank you for the resorce.

I found this book put together well. If you are interested in a career of Medical Billing and Coding, this book is for you. It was easy to understand. I worked in the Central Business Office in my area that supported many hospitals and various health organizations. I wanted to learn more about the billing and coding side. This book helped me to get a preview of what I will be learning when my actual classes begin in a few months.

Unfortunately, this book won't impart a grasp of the fundamentals of medical billing/coding comparable to the one Coach John Wooden's players received for basketball, but I work in the field, and the authors aim--more or less successfully--at imparting such a grasp.

The meeting of health care and computers is key to medical billing and coding. Medical records is the last field to computerize. Opportunities abound.

The book is part of a McGraw Hill series, the pedagogical format of which is good.

I was given Understanding Health Insurance, 10th Edition at work, hardly a reader-friendly book. De-Mystified is a stepping-stone to it.

Table of Contents:

CHAPTER 1
Introduction to Medical Billing and Coding
The Economics of Healthcare
A Brief Look Back at Healthcare

Did you ever wonder how physicians and hospitals get paid? Probably not because in the United States we normally don't pay for medical care directly; instead our medical insurer pays for it. We simply visit our physician's office or the hospital and provide information about our health insurance. We might be asked to pay a token amount called a copay, but that's a fraction of the total medical bill. In this chapter, you'll be introduced to the business aspects of healthcare.

CHAPTER 2
Ethical and Legal Aspects of Medical Billing
Ethics and Medical Billing
Legal Aspects of Medical Billing
Contracts
Types of Criminal Law
Confidentiality

Medical insurance specialists work with patients' confidential medical records and therefore must adhere to ethical and legal standards common to the medical profession. This chapter discusses those standards and how to comply with them.

CHAPTER 3
Medical Terminology and Procedures
The Secret to Understanding Medical Language
Mastering Medical Terminology
Strategy for Learning Medical Terminology
Medical Tests, Procedures, and Treatments

As a medical insurance specialist you'll need to become fluent in medical terminology in order to properly code medical procedures to prepare medical bills for a healthcare facility. Learning medical terminology might seem overwhelming at first. However, in this chapter you'll learn the secret that will make understanding medical technology come natural to you.

CHAPTER 4
Medical Office Procedures
Behind the Scenes
The Healthcare Team
Medical Office Procedures
Telephone Calls
The Answering Service
Making Calls on Behalf of the Medical Practice
Medical Records

While sitting in a waiting room you watch doctors and the healthcare team go about their business--all the time scratching your head wondering what they are doing. As a medical insurance specialist, you'll be part of that healthcare team. In this chapter, you'll learn the responsibilities of each team member, how they interact with each other, and procedures commonly used in every medical practice.

CHAPTER 5
Introduction to Diagnostic Procedures
Diagnostic Procedures
Billing Guidelines for Outpatient Claims
Billing Guidelines for Inpatient Claims
Billing Outpatient Claims in the Real World
Billing Inpatient Claims in the Real World
Understanding Symbols, Abbreviations, and Punctuation

You call it a sore throat. Your doctor calls it pharyngitis and explains that your fauces and pharynx are inflamed. Your medical insurer calls it 462. 462 is the universally recognized diagnosis code for pharyngitis and is used by medical insurance specialists on claim forms to reimburse your physician for caring for your sore throat. Medical insurance specialists must know how to translate medical diagnoses and procedures into corresponding diagnosis codes that medical insurers require to reimburse healthcare providers. You'll learn about diagnosis codes in this chapter.

CHAPTER 6
Introduction to Procedural Coding
Here's How Coding Works
The Healthcare Common Procedure Coding System
Current Procedural Terminology
Level II National Codes
Hands-on Coding

It's time to learn how billing codes are used to pay for medical procedures. There are countless medical procedures and services that healthcare professionals provide to patients every day, and each is charged separately. It is an administrative nightmare--that is, if it wasn't for a coding system that streamlines claims processing so that computers can handle most claims with little human intervention. This chapter introduces you to medical billing codes and walks you through the steps necessary to code a medical claim.

CHAPTER 7
Introduction to Insurance Plans
What Is Insurance?
Healthcare Financing
Health Insurance Premium
Assessing the Value of a Healthcare Policy
Types of Healthcare Plans
Types of Indemnity Insurance
Archer Medical Savings Accounts
Auto Insurance and Healthcare
Disability Insurance
Workers' Compensation
Liability Insurance and Healthcare

Healthcare providers will look to you as a medical insurance specialist to guide them through the maze of health insurance plans to ensure that a steady stream of reimbursements flow into the practice. This chapter shows you how to find your way through the maze of health insurance plans and gives you the foundation to advise healthcare providers on how to ensure that reimbursements are not denied.

CHAPTER 8
The Insurance Claim Cycle
Inside the Insurance Claim Cycle
The Insurance Claim
Health Insurance Portability and Accounting Act
Types of Health Insurance Coverage

Processing medical claims is a mission-critical function for every physician practice, hospital, outpatient clinic, hospice, and laboratory. Any delay in processing directly impacts the bottom line because it delays payment. In this chapter, you'll learn about the insurance claim cycle and about how to avoid unnecessary delays in receiving reimbursement from medical insurers. You'll also learn about different types of healthcare coverage that the medical insurance specialists must deal with daily.

CHAPTER 9
Billing and Coding Errors--How to Avoid Them
The Hidden Cost of Errors
Types of Errors
The Penalty for Coding Errors

A constant, dependable stream of reimbursements from insurers is the blood that keeps a medical practice and a healthcare facility alive. Reimbursements stop flowing when insurers deny claims or delay processing them. And coding and billing errors are the major reasons why this happens. The medical insurance specialist's responsibility is to keep reimbursements flowing by making sure all claims are error-free before they are sent to an insurer for processing. In this chapter you'll learn the most common mistakes that cause insurers to reject claims.

CHAPTER 10
Strategies for Handling Claim Disputes
The Claim Adjudication Process
Following up on a Claim
Remittance Advice
The Appeal
The Appeals Strategy

Every insurance claim undergoes an adjudication process during which a claims examiner determines if the claim is covered by the terms of the patient's insurance policy. If the claim is denied, the healthcare provider--and the patient--can appeal the claims examiner's decision. In this chapter you'll learn how to resolve claims disputes without going through an appeal. You'll also learn how to develop a winning strategy for an appeal.

CHAPTER 11
Medical Billing Software Programs and Systems
Computerization
A Computer Program
The Medical Manager

Nearly 75% of medical insurance claims and all Medicare claims are processed electronically using a computer program resulting in 98% of those claims being reimbursed within 30 days. Today medical insurance specialists must be as well versed in medical management computer programs as they are in medical insurance. In this chapter, you'll learn about computer technology and how to perform common tasks using one of the most widely adopted medical management computer programs in the industry.

CHAPTER 12
Finding Employment in the Healthcare Industry
Employment Prospects
Educational Requirements
Skills and Responsibilities
Finding a Job
Preparing Your Resume
Cover Letters
Online Submission
Job Search
You're in the Preliminary Finals
Preparing for the Interview
The Interview
After the Interview

Finding your first job as a medical insurance specialist is a challenge because you'll need to convince a prospective employer to bring you on board his healthcare team. Medical insurance specialists are in demand by healthcare providers in private practice, healthcare facilities, insurance companies, and private industry that need someone to help them manage their medical benefits program. In this chapter you'll learn strategies for job searching and techniques for preparing and submitting resumes and interviewing with prospective employers.

I love all of the "DeMystified" books I have ever ordered. They are all written in very easy to understand terms, and are well worth the investment. This one got me through a difficult spot in my billing and coding classes, and made what my textbook was saying make sense. Would recommend it to anyone needing additional help on this subject.