1. Comprehensive Health Insurance Billing, Coding, and Reimbursement Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Chapter 1 Introduction to Professional Billing and Coding Careers

2. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Introduction to Billing and Coding Careers  Many opportunities can be found for the professional healthcare reimbursement specialist.

3. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Facilities  Physician's practice  Solo practice: Single physician  Small group practice: 2-3 physicians  Large group practice: 4-5 or more physicians

4. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Hospitals  Patient account services facility (PAS)  Centralized billing office (CBO)

5. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Job Titles and Responsibilities  Medical Office Assistants- may also be known as an administrative medical assistant, secretary or medical receptionist. –Usually work in physician's offices and are considered front office staff administrative duties

6. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Job Titles and Responsibilities  Medical Billers- handle submission of insurance claims, data entry, and contacting insurance companies regarding incorrectly paid claims  Medical Coders- conduct research and reference check of medical records and are responsible for accurate coding of the primary/secondary diagnoses and procedures

7. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Job Titles and Responsibilities  Registered Health Information Technician- may also be referenced as coder, file clerk, health information clerk, medical records director, medical records technician or office manager –Compiles, processes, and maintains medical records

8. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Job Titles and Responsibilities  Payment Poster - generally reads the Explanation of Benefits documents issued by insurance carriers and posts the payments or contractual adjustments to the appropriate patient account  Medical Collector- contacts patients and insurance carriers to collect money owed to the medical facility

9. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Job Titles and Responsibilities  Refund Specialist - analyzes patient accounts to discern whether or not a refund is required, and if so, to whom the money should be returned  Insurance Verification Representative- contacts insurance carriers to verify benefit information for patients. May also perform precertification and/or prior authorization of service duties.

10. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Job Titles and Responsibilities  Admitting Clerk- responsible for registering and greeting patients, having patients complete paperwork, answering questions, data entry of patient demographic and insurance information, and requesting information and payment

11. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Job Titles and Responsibilities  Patient Information Clerk- responsible for answering questions about and explaining HIPAA privacy regulations, living wills, DNR orders, and other information to patients and their family members

12. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Reasons for Obtaining Certification  Stay current in your field.  Excellent addition to your resume  Professional journals/newsletters  Networking

13. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Organizations that Offer Certification to the Medical Office Specialist  American Health Information Management Association (AHIMA)  American Academy of Professional Coders (CCPC)  National Center for Competency Testing (NCCT)  National Healthcareer Association (NHA)

14. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Certifications  Medical office assistant certification –National Certified Medical Office Assistant –Certified Medical Administrative Assistant  Medical billing certifications  Certified Medical Billing Specialist

15. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes Certifications  Medical coding certifications –Certified Coding Associate –Certified Professional Coder –Certified Professional Coder- Hospital –Certified Coding Specialist –Certified Coding Specialist- Physician  Medical records certification –Registered Health Information Technician