Monday, December 8, 2008

Nursing Leadership Management and Professional Practice for the LPN LVN or Guide to Medical Billing and Coding

Nursing Leadership, Management and Professional Practice for the LPN/LVN: In Nursing School and Beyond

Author: Mary Ann Anderson

Mary Ann Anderson's personal, easy-to-read style covers the most sophisticated content in a manner that you, the LPN/LVN student, will easily understand. This new 3rd edition combines the early curriculum content covered in her acclaimed To Be a Nurse: Personal/Vocational Relations for the LPN/LVN text with the late curriculum leadership and management content found in the previous editions of this book. This approach provides you with the only book that you will need to examine professional practice issues throughout the entire LPN/LVN curriculum.

Doody Review Services

Reviewer: Mary Allen Carey, PhD(University of Oklahoma College of Nursing)
Description: This book on leadership, management, and practice for the LPN/LVN uses a case-study format driven by clear objectives.
Purpose: The purpose is to provide LPNs/LVNs with the knowledge they need to assume the leadership-management roles asked o f them. The author has achieved the objectives.
Audience: The book is written for LPN/LVN educators and students. The author is a credible authority.
Features: The emphasis of the book is on humanistic aspects of caring based on the nursing science theory of Dr. Jean Watson. The book's 19 chapters are grouped into two units -- the nursing profession in today's healthcare environment and the student transition to nurse.
Assessment: This book is unique in focus. The differentiation of nursing leadership and management at all levels of nursing is an extremely important task.



Table of Contents:

1Historical perspective and current trends3
2Caring as a personal and professional behavior19
3Understanding the changing roles in nursing37
4Healthcare environment57
5Fulfill your role as a student77
6The importance of critical thinking97
7Entry into practice113
8Employment process131
9 Leadership and management as a professional concept145
10Communication skills in leadership and management167
11Considering culture185
12Understanding benefits of change203
13Welcome to conflict221
14Dealing with chaos239
15Ethics and law in nursing management257
16Understanding use of power279
17Motivating employees295
18Team building311
19Making assignments, counseling, and analyzing performance323

Books about marketing: Center for Creative Leadership Handbook of Leadership Development or Group Counseling

Guide to Medical Billing and Coding: An Honors Certification Book

Author: Inc ICDC Publishing

Medical billing is one of the fastest-growing employment opportunities in the United States today.  Insurance companies, medical offices, hospitals and other health care providers are in great need of trained personnel to create medical claims.  This book will ensure learning the skills necessary to become a  successful medical claims biller.  It is presented in a comprehensive, yet user friendly way, following a logical learning format beginning with a broad base of information and then, step by step, following the course for creation of a medical claim.

This book teaches the skills necessary to become a well-rounded medical biller.  By completing this course of study with a satisfactory grade, the user will be granted a certificate and can have the opportunity to work towards an "Honors Certificate", which is even more valuable to a potential employer.



Table of Contents:

SECTION I. MEDICAL PRACTICE ADMINISTRATION.

1. Introduction to Medical Billing and Coding.

Job Roles and Duties

The Medical Team

Types of Healthcare Settings

Basic Skill Requirements of the Medical Biller

Interpersonal Skills

On The Job Now (Special Feature)

Stress

On The Job Now (Special Feature)

Pre-Vacation Work Planning

Certification Programs for Medical Billers

Legal Issues

Privacy Guidelines

Fraud

HIPAA and Fraud and Abuse

Embezzlement

Employee Bonding and Errors and Omission Insurance

Claim Audits

Practice Pitfalls (Sp ecial Feature)

Medical Ethics

Subpoenas

Instances in Which the Patient Should Be Notified and the File Notated

Summary

Assignments

Questions for Review

Exercises 1 — 1 through 1 — 3

Honors Certification™

2. Clinical Records and Medical Documentation.

Medical Charts

Filing the Chart

Medical Documentation Rules

SOAP Notes

Signature Cards

Retention of Records

Practice Pitfalls(Special Feature)

Storing Medical Records

Practice Pitfalls (Special Feature)

Electronic Medical Charting

Computerized Files

Record Transfers

Patient Information Sheet

On The Job Now (Special Feature)

Release of Information Form

Assignment of Benefits Form

Patient History Form

Insurance Verification

Practice Pitfalls (Special Feature)

On the Job Now (Special Feature)

Additional Suggestions

Summary

Assignments

Questions for Review

Exercises 2 — 1 through 2 — 3

Honors Certification™

SECTION II. HEALTH INSURANCE PROGRAMS.

3. Health Insurance Contract Interpretation.

Blue Cross/ Blue Shield

Contract Provisions

On the Job Now (Special Feature)

Contr act Benefits

On the Job Now (Special Feature)

On The Job Now (Special Feature)

On The Job Now (Special Feature)

Practice Pitfalls (Special Feature)

On The Job Now (Special Feature)

Practice Pitfalls (Special Feature)

On The Job Now (Special Feature)

Exclusions

Allowed Amounts

Practice Pitfalls (Special Feature)

Pre-certification of Inpatient Admissions

Utilization Review

Second Surgical Opinion Consultations

On The Job Now (Special Feature)

Coordination of Benefits

On The Job Now (Special Feature)

Summary

Assignments

Questions for Review

Exer cises 3 — 1 through 3 — 6

Honors Certification™

Sample Insurance Contracts

4. Medicare and Medicaid.

Medicare

Medicare Eligibility

The Parts of Medicare

Practice Pitfall (Special Feature)

On The Job Now (Special Feature)

Allowable Charges

Medicare Health Insurance Card (HIC)

Practice Pitfalls (Special Feature)

Medicare Physician Identification Numbers

Practice Pitfalls (Special Feature)

Medicare Billing Notices

Assignment of Benefits

Practice Pitfalls (Special Feature)

Practice Pitfalls (Special Feature)

Medicare Secondary Payer

Diagnosis-Related Group Billing

On The Job Now (Special Feature)

Durable Medical Equipment

Medicare Denials

Advanced Beneficiary Notice (ABN)

Practice Pitfalls (Special Feature)

The Medicare Appeals Process

Medical Fraud and Abuse

Medicare Supplemental Insurance

Medicare and Managed Care

Medicare Notice of Non-Coverage

Medicare Billing Guidelines

Practice Pitfalls (Special Feature)

Medicaid

Medicaid Covered Services

Reimbursement from Medicaid

Practice Pitfalls (Special Feature)

Medicaid as Secondary Payor

Treatment Authorization Request

Practice Pitfa lls (Special Feature)

Medicaid Billing Guidelines

Summary

Assignments

Questions for Review

Exercise 4 — 1 through 4 — 3

Honors Certification™

5. Workers' Compensation.

Intent of the Workers’ Compensation System

Employee Activities

Time Limits

Fraud and Abuse

Types of Workers’ Compensation Benefits

On The Job Now (Special Feature)

Treating Physicians

Medical-Legal Evaluations

Medical Service Order

Patient Records

Doctor's First Report of Injury/Illness

On The Job Now (Special Feature)

P rogress Reports

Practice Pitfalls (Special Feature)

Physician's Final Report

Billing for Workers' Compensation Services

Practice Pitfalls (Special Feature)

Third Party Liability

Liens

On The Job Now (Special Feature)

Delinquent Claims

Delay of Adjudication

Workers’ Compensation Appeals

Reversals

Summary

Assignments

Questions for Review

Exercise 5 — 1 through 5 — 2

Honors Certification™

6. Managed Care.

Rising Health Care Costs

Managed Care

HMO Coverage

< p> Preferred Provider Organizations

On The Job Now (Special Feature)

Self Insurance

Billing Managed Care Plans

Practice Pitfalls (Special Feature)

Practice Pitfalls (Special Feature)

On The Job Now (Special Feature)

Practice Pitfalls (Special Feature)

Groups/IPAs

Practice Pitfalls (Special Feature)

Group/IPA to Physician Risk

Capitation Payments

Practice Pitfalls (Special Feature)

Appointment Scheduling

Authorizations, Referrals, and Second Opinions

Denial of Services to Members

Member Grievances and Complaints

Transfers

Disenrollment

Continuing Care

Miscellaneous Services

Practice Pitfalls (Special Feature)

Practice Pitfalls (Special Feature)

Sanctions

Claim Payments

Practice Pitfalls (Special Feature)

Summary

Assignments

Questions for Review

Exercise 6 — 1 through 6 — 3

Honors Certification™

SECTION III. FINANCES AND ACCOUNTING.

7. Medical Practice Accounting.

Patient Accounting

Accounts Payable/ Receivable

Patient Ledger Card/Statement of Account

Insurance Payments

On The Job Now (Special Feature)

Posting Payments

Balance Billing

Follow-Ups

On The Job Now (Special Feature)

Collections

Collections Procedures

Small Claims Court

Practice Accounting

Petty Cash

The Day Sheet/Daily Journal

Office Reports

Summary

Assignments

Questions for Review

Exercise 7 — 1 through 7 — 4

Honors Certification™

SECTION IV. MEDICAL CODING .

8. Reference Books.

ICD-9

CPTâ 9

Medical Dictionary

Merck Manual

On The Job Now (Special Feature)

Physicians' Desk Reference

On The Job Now (Special Feature)

HCPCS

On The Job Now (Special Feature)

On The Job Now (Special Feature)

On The Job Now (Special Feature)

On The Job Now (Special Feature)

Summary

Assignments

Questions for Review

Exercise 8 — l through 8 — 8

Honors Certification™

9. International Classification of Disease (ICD-9) Coding.

History of the ICD-9

Contents of the ICD-9

How to Use the ICD-9

General Guidelines

Practice Pitfalls (Special Feature)

Main Terms

Practice Pitfalls (Special Feature)

On The Job Now (Special feature)

Exceptions

On The Job Now (Special feature)

V Codes

Practice Pitfalls (Special Feature)

E Codes

Signs and Symbols Used in the ICD-9

ICD-10

Summary

Assignments

Questions for Review

Exercises 9 — 1 through 9 — 10

Honors Certification™

10. Current Procedural Terminology (CPTâ) Coding.

Using the CPTâ

Semicolons in the CPTâ

Signs and Symbols Used in the CPTâ

Using the CPTâ Index

Modifiers

Unlisted Codes

Evaluation and Management Codes

On The Job Now (Special feature)

Practice Pitfalls (Special Feature)

Anesthesia

On The Job Now (Special feature)

On The Job Now (Special feature)

Surgery

Practice Pitfalls (Special Feature)

Practice Pitfalls (Special Feature)

On The Job Now (Special feature)

On The Job Now (Special feature)

Radiology/X-ray

On The Job Now (Special feature)

Pathology/Laboratory

On The Job Now (Special feature)

Practice Pitfalls (Special Feature)

On The Job Now (Special feature)

Medicine

On The Job Now (Special feature)

Summary

Assignments

Questions for Review

Exercises 10 — 1 through 10 — 11

Honors Certification™

SECT ION V. MEDICAL BILLING.

11. The CMS-1500 Form and Medical Billing Procedures.

Superbill

CMS-1500 Form

CMS-1500 Block Explanations

Practice Pitfalls (Special Feature)

Patient Claim Form

On The Job Now (Special feature)

Billing for Service

Incomplete Data Master List

Determining the Proper Billing Amount

Practice Pitfalls (Special Feature)

Special Services

Claims Submission Process

Practice Pitfalls (Special Feature)

Clean Claims

Coordination of Benefits

COB With Health Maintenance Organizations

Collecting the Patient Portion

Practice Pitfalls (Sp ecial Feature)

On The Job Now (Special feature)

TRICARE

Practice Pitfalls (Special Feature)

Billing Reports

Prompt Payment Laws

Tracer Claims/ Delinquent Claims

Denied Claims

Re-submission of Claims

Adjusted Claims

Review and Appeals

Balance Billing Patients for Downcoded or Denied Claims

State Insurance Commissioner

Maximum Reimbursement Guidelines

Summary

Assignments

Questions for Review

Exercise 11 — 1

Honors Certification™

12. The UB-92 Form and Hospital Billing Procedures.

Field Locator # and Name/Description

On The Jo b Now (Special feature)

Item 42, Hospital Revenue Codes

On The Job Now (Special feature)

On The Job Now (Special feature)

Item 53, Assignment of Benefits

On The Job Now (Special feature)

Practice Pitfalls (Special Feature)

On The Job Now (Special feature)

Chargemaster Descriptions

Entering Charges

How Billing Affects Other Departments

Preauthorization, Pre-certifications and Utilization Reviews

AmbulatorySurgical Centers

Summary

Assignments

Questions for Review

Exercise 12-1 through 12-4

Honors Certification

13. Abstracting, Billing and Coding From Medical Reports.

Abstracting From Medic al Records

Triage Reports

Operative Reports

Diagnostic Testing Reports

Medical History and Physical Examination Reports

Summary

Assignments

Questions for Review

Exercises 13 — 1 through 13 — 21

Appendix 13 — 1

Triage Report 1

Triage Report 2

Operative Report 1

Diagnostic Report 1

Medical History and Physical Examination Report

Honors Certification™

SECTION VI. GENERAL OFFICE PROCEDURES.

14. Basic Office Functions and Communications.

Mail

On The Job Now (Special feature)

On The Job Now (Special feature)

On The Job Now (Special feature)

Office Machines

Tickler Files

Practice Communications

Practice Pitfalls (Special Feature)

The Opening

The Body

The Closing

Correspondence Containing Negative Content

Format of the Letter

Practice Pitfalls (Special Feature)

On The Job Now (Special Feature)

Practice Pitfalls (Special Feature)

On The Job Now (Special Feature)

Memos

Patient Relations

First Impressions and Image

Customer Service Job Functions

The Art of Listening

On The Job Now (S pecial Feature)

On The Job Now (Special Feature)

Maintaining an Appointment Calendar

On The Job Now (Special Feature)

Summary

Assignments

Questions for Review

Exercises 4 — 1 through 4 — 3

Honors Certification™

SECTION VII. SECURING EMPLOYMENT.

15. Job Search Preparation.

Key Descriptions

On The Job Now (Special Feature)

Printer Tape Symbols

Calculator Basics

On The Job Now (Special Feature)

The Computer

The Monitor

The Keyboard

On The Job Now (Special Feature)

Practice Pitfalls (Special Feature)

Computer Terms

Practice Pitfalls (Special Feature)

Computer Basics

Job Search Objectives

Uniqueness

Target Audience

Build Your Database

The Resume

Practice Pitfalls (Special Feature)

The Cover Letter

Marketing Yourself

The Job Interview

Getting Paid What You Are Worth

Summary

Assignments

Questions for Review

Exercise 15 — 1 through 15 — 6

Resume Questionnaire

Honors Certification™

SECTION VIII.

Appendix A. Provider and Medical Abbreviations.

Provider Abbreviations

Medical Abbreviations

Appendix B. Forms.

Patient Information Sheet

Patient Encounter Form

Insurance Coverage Form

Pre-authorization Request

Doctor’s First Report of Occupational Injury of Illness

Lien Letter

Lien Form

Statement of Account

Insurance Claim Tracer

Petty Cash Count

Received of Petty Cash

Day Sheet/Daily Journal

Deposit Slip

CMS-1500 Claim Form

UB-92 Billing Form

Patient Claim Form

Superbill/Charge Slip

Return Receipt

Certified Mail Form

Ground Tracking ID COD Prepaid

COD Airbill

COD Shipper Receipt

Ground Tracking ID Prepaid

Airbill

Stationery

Provider Envelope

Appendix C. Tables.

Patient Information L isting

Provider Information Listing

Order of Benefit Determination

Medicare Secondary Payer

Quick Reference Codes

Place of Service Codes

Hospital Revenue Codes

Hospital Field Locator Codes

State Abbreviations

Other Address Abbreviations

Appendix D. CMS-1500 Form Matrix.

CMS-1500 Sample Claims

Appendix E. UB-92 Form Matrix.

UB-92 Sample Claims

Glossary

Answer Keys for “On The Job Now” Exercises

Index

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