Book Description

Begins with an introduction to Current Procedural Terminology (CPT), followed by in-depth explanations of the sections in the CPT manual.Unit 2 covers the International Classification of Diseases, 9th Revision, Clinical Modification (ICD 9-CM). Unit 3 concerns third party reimbursement. Appendix provides the official ICD-9-CM guidelines for coding and reporting. A new feature, From the Trenches, highlights a different real-life medical coding practitioner in each chapter, with photographs throughout the chapter alongside quotes that offer practical advice or motivational comments. A new workbook supplements the text with more than 1,000 questions and terminology exercises, as well as original source documents to familiarize the reader with documents they will encounter in practice. ISBN for Workbook is 0-7216-9349-0. ... Read more

Reviews (17)

No Answer Key
I purchased this book for an online medical coding and reimbursement class. Overall I was disappointed. Although the author gives good examples of coding procedures, sometimes she doesn't follow through with showing examples of some of the more complex coding rules. Most frustrating was not having an answer key for readers to check their answers to the numerous exercises... particularly since medical coding stresses "accuracy, accuracy, accuracy". The frequent hand symbol of stop! was very annoying. The book does have useful info that is clearly written. However, I would not recommend spending the money for this book without an answer key included. ...

Thumbs Up for this Useful Book
As preparation for the CCS examination, I find this book to provide excellent background material on the CPT classification system and outpatient medical coding. I'm in the beginning stages of using the text; but I am immediately impressed. It seems logical, thorough, and well-organized. While the coding exercises are an aid, it is the supporting documentation that sets this book apart from other review books I have been using. I give it a high recommendation to those of you who are searching for a comprehensive, up-to-date resource.

GOOD PRICE
If your going to Fairleigh Dickinson University and your taking up Medical Coding and Billing you will need this book

Step-By-Step Medical Coding
This is easy to use and really works to learn medical coding. It is written so you can understand it and has a lot of questions right in the text. The answers to the questions are in the back of the book. I also got the workbook, and every other question answer is in the back of that book with hint. This really is a good book. I thought this would be hard for me to learn, but it wasn't.

Teaching with Step-by-Step
I have been using Step-by-Step Medical Coding to teach with for the last four years. I have had excellent results with the students comprehension and building of job skills. I think she has a wonderful methodology of skill building and incremental learning. ... Read more

Reviews (2)

Best Source of Reimbursement Information for Physicians
"Mastering the Reimbursement Process is the single best source for the physician, medical office staff, or others to get a comprehensive understanding of health insurance, claims submission, and the follow-up necessary to get paid by third parties." - Michael T. Myers, Jr, MD, MBA, Director, Health Care Regulatory Group, PriceWaterhouseCoopers LLP

Great resource for any physician practice !
With Medicare compliance and false claim risks increasing, this is a wonderful guide for Physicians and those who bill for them. ... Read more

Book Description

To accompany the hugely successful 'Methods for Economic Evaluation of Health Care Programmes 2e', this book is a thorough and rigorous discussion of the methodological principles and recent advances in the rapidly advancing field of theory and practice of economic evaluation in health care. Written by an internationally aclaimed group of authors, the book provides an in-depth discussion of the latest theoretical economic evaluation, including the methods for measuring costs and outcomes, the collection of data alongside clinical studies, ways of handling uncertainty, discounting and issues relating to the transferability of economic data. It is an ideal book for those studying economic evaluation on postgraduate or professional courses in health economics of public health. ... Read more

Reviews (1)

An important resource
With all that is going on with Enron and my own concerns about retirement plans and social security this book is a must have. The author fills the book with valuable information and insights regarding not just the history of social security, but what it all means for me and my future. I recommend this for anyone planning for their retirement and anyone interesting in knowing what the future of social security means for them. ... Read more

Book Description

Offers step-by-step instructions on how to prepare a well-grounded claim for veterans’ benefits

The most comprehensive "do it yourself" handbook for veterans who wish to obtain federal benefits

Provides an insider’s perspective on the VA’s claims adjudication and appeal processes

"Claim denied!" All too often millions of veterans have received this response to their legitimate claims for Federal benefits. In most cases, writes veterans’ advocate John D. Roche, the claimant didn’t understand the procedures needed to meet the myriad requirements of the Department of Veterans Affairs. With the appeals process requiring years to resolve disputes, deserving veterans and their dependents are left confused and frustrated by the agency and a system that was created to serve them. The answer is to submit a well-grounded claim initially, which The Veteran’s Survival Guide analyzes in detail. Written in an accessible self-help style, Roche’s book should be required reading for any veteran or veteran’s dependent who wishes to obtain their well-earned benefits and for those officials of veterans service organizations whose job it is to assist veterans with their claims. ... Read more

Reviews (3)

God Bless Mr. Roche
I was injured in Viet Nam, and have been looking for these records for 20 years, and now thanks to Mr Roche and his book, I have now found these records. This was after the VA had told me that they would find the records for me, which they did not. This is a must read for all veteran that deal with the VA. Thank you Mr Roche!!

Finally a book on how to REALLY DEAL with the VA
Finally a book on how to really deal with the VA! For 30 years my husband fought with the VA to get his disability. With the help of author John Roach and this "survival guide", his disability was finally granted this year. This book has an easy to understand approach with the information you can't get from the VA or anyplace else. No one should attempt the VA claims process without this book. A "must have" for every veteran.

The Best Book I Have Found To Win Against The VA
My husband's VA claim was recently approved after almost 4 years. I can say beyond a shadow of a doubt that I could of never gotten the information or guidance along the way of fighting the VA system had I of not had John Roche's book. It is by far the most well informed book any veteran could ever get and I only wish I could of had it sooner. Any veteran getting ready to file a claim with the VA buy this book first. You will find out the VA don't volunteer alot of information to you and this book will help guide you through your claims process. ... Read more

Book Description

This much anticipated new edition of Health Care Economics continues its legacy as a leader in its field.Written by a distinguished economist and educator, the sixth edition maintains the books analytical approach in its treatment of political economics.Through comprehensive discussions, appendices, tables and figures, the author consistently illustrates the value of economics in understanding public policy issues that affect the medical services sector. Both veterans in the field of economics and readers who are new to this area of study will appreciate the books in-depth and straightforward treatment of important topics. ... Read more

Book Description

An explanation of how thieves exploit the U.S. health system and steal more than $100 billion each year.Fraud and abuse bleeds more than 100 billion dollars each year out of the U.S. health system. This detailed examination shows the problem is worse than almost anyone knows, mostly invisible, and still far from controlled. Sparrow reveals that current control systems fail by presenting fraud perpetrators with a safe, easy-to-hit target: fully automated check-printing systems, which only require thieves to bill "correctly," regardless of whether or not any medical service is provided. This target attracts an extraordinary range of criminal entrepreneurs, from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, even major hospital chains. Sparrow's research examines the much-misunderstood effects of managed care on the problem, the government's recent attempts to grapple with fraud, and the campaign by various provider associations to undermine those efforts.TOC: PrefaceAcknowledgmentsIntroductionFictitious CompaniesThe State of the ArtControl FailuresTwo Distinct Sciences: Fraud Detection, and Utilization Review, How Goes the War?Counterattack, New Frontiers for ControlFalse ClaimsManaged CareThe Nature of the Fraud-Control ChallengeThe Pathology of Fraud ControlThe Importance of MeasurementAssessment of Existing Fraud-Control SystemsThe Antithesis of Modern Claims ProcessingPrescription for ProgressA Model Fraud-Control StrategyDetection SystemsConclusionAcronyms and AbbreviationsNotesIndexBIO: Malcolm K. Sparrow teaches Regulatory and Enforcement Strategy, and Analytic Methods, at Harvard's John F. Kennedy School of Government.Formerly a Detective Chief Inspector with the British police service, he now specializes in issues of enforcement strategy, regulatory compliance, and risk control--he is the acknowledged national expert on the subject of Health Care Fraud. He is author of The Risk Business: Defining the Regulatory Craft (2000), License to Steal: Why Fraud Plagues America's Health Care System (1996), Imposing Duties: Government's Changing Approach to Compliance (1994); and co-author of Beyond 911: A New Era for Policing (1990) and Ethics in Government: The Moral Challenge for Public Leadership (1990). ... Read more

Reviews (3)

No real point at all!
This book did not really need to be written. It is written by a fraud investigator and is about nothing but specific fraud in Medicare, but we already knew there was tremendous Fraud. If you didn't know that billions are stolen in every conceivable way you do now, and don't need to read the book.
Yes, the gov't sends out $250 billion each year for healthcare related goods and services while somewhere between 5-50% is pure fraud, but what do we do? If you want a Fraud investigators answer: simply improve the software to spot anomalous patterns like one patient with 20 primary care providers in one month. If you want to know one new thing that has not been suggested and tried a million times before you will not find it here.
Creative and brilliant ideas such as medical savings accounts where each American deposits his own tax dollars his own medical savings account and is thereby given the maximum incentive to spend wisely are not considered. What is considered exclusively is fine tuning the likes of which have been tried and tried for the last 45 years.

Finally, someone who "gets it"!!!
This is a remarkable book which opens the readers eyes to some of the "real" issues in the financial state of healthcare in the United States. It pulls together what the people in the trenches have struggled with for years ... and puts it into an easy to read text that you just CAN'T put down. This should be required text for anyone working in healthcare or anyone who receives care from the system.

Straight talk on fraud
Although he has a wealth of expertise and a scholar's background, Sparrow speaks in a narrative style about the sad state of health care fraud in America today. While some progress is being made, there remains a little depth and sophistication in the responses to the complex and clever fraud schemes out there. Regretably, the many policitcal and institutional barriers to mesuring and uncovering fraud continue to allow the system to be drained of precious dollars. While it takes a large investment to begin the fight on the level Sparrow advocates, the return is immeasurably greater. Not recommended for folks who don't need their blood pressure to rise. ... Read more

Book Description

This is the most comprehensive HCPCS book available.It contains important information, as dictated by CMS, but presents it in an easy-to-use format to guide the coder confidently through current codes and modifiers, as well as code changes, additions, and deletions. ... Read more

Book Description

This newly updated and expanded edition of The Economics of Health and Medical Care strikes the necessary balance of population-based health economics and the more traditional, market-oriented approach to health care economics. The Fifth Edition provides the necessary tools to develop a systematic and disciplined approach for solving economic problems in a health care context while learning the importance of being able to identify, define, measure, explain, and predict certain economic phenomena and evaluate the relevance of end results. Fundamental, yet comprehensive in coverage, the focus is on how to think about economic problems in a systematic way--using the three major tasks of economics--Descriptive Economics, Explanatory Economics, and Evaluative Economics ... Read more

Book Description

• File claims that get paid
• Get more sessions for your clients
• Take the stress out of communicating with managed-care companies
• Promote your clients’ Confidentiality

Learn to take charge of managed care

A "how-to" guide for dealing with the everyday practice issues related to working with managed care.Written by an industry insider, Managing Managed Care offers a candid and unprecedented behind-the-scenes view, with focus on issues of vital importance to today’s practitioner:

• Understanding the "participating-provider" contract
• Challenging fee reductions
• Writing treatment reports in "managed-care- friendly" language to enhance the likelihood of obtaining continued authorization
• The nuts and bolts of "medical necessity"
• Effectively fighting denials of care
• Getting claims paid

Managing Managed Care features insights from case managers, other managed-care employees in critical areas such as network, quality, consumer service, and managed- behavioral care company executives.Learn why they close the panels.Who gets the referrals, and why?How are managed-care and insurance companies shifting financial risk to practitioners?How is managed care itself changing as a result of market pressures?What effect does NCQA have on managed-care companies?How does all this affect you and your clients, and what can you do about it?

... Read more

Reviews (4)

Should be required reading for anyone in private practice
I highly recommend this book to all the clients of my billing service; in fact, I gave copies for Christmas one year! Therapists are launched into private practice with no clue about how to deal with insurance companies or managed care. Suddenly they have to learn (usually the hard way) how to fill out treatment plans and work with case managers. Susan Frager maps out this new world in a clear fashion, and in language familiar to the clinician.

The classic example of not judging a book by its cover
Don't be fooled by the new title and cover, it's the same book inside. Not one word has been changed - I hope!

If you want to learn to "manage managed care," this is your book. It is certainly one aspect of private practice, but a truly "Successful Private Practice" is so much more than knowing how to navigate managed care. One of these days, maybe I will write the real "Successful Private Practice!"

From a billing service point of view
Any well written handbook is a plus to any mental health office. The information on what should really go on a treatment plan is useful information for a billing service or office manager to pass on to their therapists. This book teaches the therapist a "cooled-down" approach to dealing with the managed care companies instead of an antagonistic approach. Start-up billing services will also find the billing-specific information helpful. This information is spelled out clearly and is easily understood.

Calming the mental health provider
This book is excellent. The author's information is presented clearly, giving us mental health providers reassurance that we have a chance with Managed Care. The book is well organized and the information is helpful. Managed Care is a bureaucracy and we must learn the language and the procedures if we are to use Managed Care. This book will help you do that. If you are new to the field and considering Managed Care as a referral source, this is an excellent tool. If you have been struggling with Managed Care for some time, do not hesitate. This book will help you manage your managed care referrals so that you can be a more effective therapist. If you are a mental health provider and are debating about becoming a managed care panelist, you owe it to yourself to read this book before you take the plunge. ... Read more

Book Description

Text provides a step-by-step plan to help adopt the new HIPAA transaction standards. Provides a step-by-step plan in a variety of healthcare settings to prioritize transactions adoption, coordinate transaction efforts with vendors and payers, identify short-term and long-term effects, and introduce the X12N architecture for electronic transmission. Softcover. ... Read more

Book Description

In terms of health care, Americans want incompatible results—unlimited access to the best care, at affordable prices. With health care assuming an increasing proportion of the American economy, it is vital that health care managers and providers have a comprehensive understanding of finance and economics. This text will help you meet the considerable challenge of cutting costs while enhancing service quality.

Health Care Finance and Economics will provide you with a complete understanding of financial management and health economics. You’ll develop your role as a manager by learning how to: enhance productivity, market strategy, quality, and profitability; manage capital structure, investment decisions, and financial decisions; improve access to health care, promote managed care, and learn from technology assessment studies; and evaluate what a payer can do to buy prudently yet preserve the biomedical strength of the nation. ... Read more

Book Description

This title is part of the UniversityOfHealthCare/ UniversityOfBusiness Interactive Training Library, which offers authoritative, clearly written material in an interactive form for better comprehension and documentation of completion. This course should be used for two purposes: informing one's organization about fraud and abuse and for documenting their training as part of a compliance program. Upon the completion of this course, you will be able to define and differentiate fraud and abuse, list examples of fraud and abuse, list some statutes that are relevant to fraud and abuse and their basic contents, define a qui tam suit, describe some of the actions that the OIG takes, describe the circumstances that lead to exclusion from federal healthcare programs, describe at least 15 terms referring to improper billing practices, and give examples for at least 10 types of improper billing practices. Estimated time: 1-2 hours. 125 pages. You must have Internet Explorer 4.0 or higher running on your computer. Supported operating systems are Windows 95, 98, 98 SE, ME, 2000, or XP. You will need Internet access to e-mail us your unique key and receive a password key. License is for one user on one computer. ... Read more