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See Most Recent Edition

Understanding Health Insurance: A Guide to Billing and Reimbursement, 2024 Edition, 19th Edition

Michelle A. Green

  • Copyright 2025
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Starting At £45.00 See pricing and ISBN options
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Understanding Health Insurance: A Guide to Billing and Reimbursement, 2024 Edition 19th Edition by Michelle A. Green
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Overview

Prepare students for successful careers in revenue management, medical billing or health insurance processing with Green's UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2024 Edition. Updated annually, this reader-friendly resource highlights the latest developments in health care insurance and revenue management, as well as recent changes to ICD-10-CM, HCPCS Level II and CPT® codes and coding guidelines. Students will acquire valuable knowledge about health insurance, managed care, legal and regulatory issues, coding systems and compliance, reimbursement and revenue management, clinical documentation, as well as coding for medical necessity and common health insurance plans. This best-selling resource offers a range of print and digital options to best suit your classroom needs. Alongside the core text, an accompanying student workbook provides application-based assignments and case studies. The comprehensive MindTap online courseware includes specialized software for SimClaim CMS-1500 claim simulation, allowing for easy integration with your school's LMS and gradebook functionality.

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Meet the Authors

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Michelle A. Green

Michelle Green has served in the capacity of full-time or adjunct faculty member as needed since 2017, and during Spring 2023 was named interim program director in the health information technology department at Mohawk Valley Community College in Utica, New York. She was the SUNY Distinguished Teaching Professor in the physical and life sciences department at the State University of New York College of Technology at Alfred for more than 30 years. She has authored three popular textbooks related to coding, revenue management and health information management. An active member of the AAPC and American Health Information Management Association, Green has been recognized for her excellence in teaching as well as her significant contributions to the health information management profession. Her numerous accolades include the State University of New York Chancellor's Award for Excellence in Teaching, Alfred State College's Alumni Association Teacher of the Year, Who's Who Among America's Teachers, AHIMA's FORE Triumph Educator Award and NYHIMA’s Educator Award. In addition, she is a Registered Health Information Administrator, a fellow of the American Health Information Management Association and a Certified Professional Coder. She earned an MPS from Alfred University and a Bachelor of Science from Daemen College.

What's New

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  • The 2024 Edition includes updated health insurance and medical billing concepts, focusing on essential skills for healthcare professionals. New content covers hospital price transparency, CMS Measure Inventory Tool (CMIT), CMS Measures Under Consideration Entry/Review Information Tool (MERIT), measures under consideration (MUC), CMS National Quality Strategy and Medicare Value-Based Care Strategy. Professional billing content is clarified, new content on intelligent automation has been added and new illustrations of the original Medicare appeals process for Parts A and B are now included.
  • This latest edition includes carefully updated instructions for completing insurance claims within chapters 11-17. Revisions reflect the latest requirements to prepare students to seamlessly transition their skills from academic to professional environments.
  • Chapters 6-17 include new and revised ICD-10-CM, CPT® and HCPCS Level II codes for 2024. All explanations, exercises and reviews within these chapters reflect the latest coding changes, the most up-to-date coding guidelines and their impact on assigning codes.

Features

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  • Clear learning objectives at the beginning of each chapter allow students to self-assess comprehension of chapter content. In addition, boldfaced key terms appear throughout each chapter to help students master the technical vocabulary associated with billing, coding, reimbursement and claims processing. The text's proven learning design methodology clearly maps chapter content both to major topics to be covered and to well-defined learning objectives.
  • Clear instructions for completing CMS-1500 insurance claims reflect current requirements, including any recent changes. Updates to instructions appear throughout the textbook and SimClaim software is available on the accompanying MindTap Courseware. SimClaim offers multiple case studies that include present billing data and patient histories. Auto-graded features, like The Simulation, provide students with instant feedback.
  • The student companion website features the latest content on ICD-10-PCS coding and official guidelines, as well as a variety of application exercises to strengthen coding skills.
  • Review questions incorporate payment calculations to provide students hands-on practice in calculating insurance or Medicare payments, co-payments and coinsurance.
  • Multiple-choice review questions help accurately assess student comprehension of chapter content, while additional questions focus on gauging understanding of key concepts and applications.
  • To gain valuable hands-on practice with key concepts, students can complete coding exercises throughout chapters 6-8 and 10, as well as claims completion exercises in chapters 11-7. Answers to exercises are available in the solutions and answer guide.

Table of Contents

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1. Health Insurance Specialist Career.
2. Introduction to Health Insurance and Managed Care.
3. Introduction to Revenue Management.
4. Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections.
5. Legal Aspects of Health Insurance and Reimbursement.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding Compliance, Clinical Documentation Improvement, and Coding for Medical Necessity.
11. CMS-1500 and UB-04 Claims.
12. Commercial Insurance.
13. BlueCross BlueShield.
14. Medicare.
15. Medicaid.
16. TRICARE.
17. Workers’ Compensation.
Appendices.
Bibliography.
Glossary.
Index.

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MindTap Options

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MindTap
Each MindTap product offers the full, mobile-ready textbook combined with superior and proven learning tools at one affordable price. Students who purchase digital access can add a print option at any time when a print option is available for their course.

This Cengage solution can be seamlessly integrated into most Learning Management Systems (Blackboard, Brightspace by D2L, Canvas, Moodle, and more) but does require a different ISBN for access codes. Please work with your Cengage Learning Consultant to ensure the proper course set up and ordering information. For additional information, please visit the LMS Integration site.

Standalone Digital Access — Ultimate Value

Recommended and most popular

  • ISBN-10: 8214109701
  • ISBN-13: 9798214109701
  • RETAIL £45.00
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Textbook Only Options

Traditional eBook and Print Options

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  • ISBN-10: 0357932161
  • ISBN-13: 9780357932162
  • RETAIL £51.50

  • ISBN-10: 0357932064
  • ISBN-13: 9780357932063
  • RETAIL £143.00
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Students: Buy now