Understanding Health Insurance: A Guide to Billing and Reimbursement

  • includes Premium Website, 2 terms (12 months) Printed Access Card and Cengage EncoderPro.com Demo Printed Access Card
  • AUTHOR: Michelle A. Green
  • ISBN-13: 9781285737522 
  • Grade(s): 9 | 10 | 11 | 12
  • 832 Pages  Paperback 
  • 12th Edition  |  Previous Editions: 2013
  • ©2015     Published
  • Prices are valid only in the respective region


About The Product

Understanding Health Insurance, 12th Edition, is the essential learning tool your students need when preparing for a career in medical insurance billing. This comprehensive and easy-to-understand text is fully-updated with the latest code sets and guidelines, and covers important topics in the field like managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. The twelfth edition has been updated to include new legislation that affects healthcare, ICD-10-CM coding, implementing the electronic health record, the Medical Integrity Program (MIP), medical review process, and more. The practice exercises in each chapter provide plenty of review, and the workbook (available separately) provides even more application-based assignments and additional case studies for reinforcement. Includes free online SimClaim™ CMS-1500 claims completion software, and free-trial access to Optum's EncoderPro.com—Expert encoder software.


  • Alerts such as the HIPAA Alerts, Coding Tips, ICD-10, and Managed Care Alerts draw attention to critical areas of content and provide experience-based recommendations.
  • Notes appear throughout and clarify content, give references, provide background, or emphasize rule exceptions.
  • Study Checklist at the end of each chapter directs students to other learning aids to enhance understanding and build confidence.
  • Practical Claim Handling: In addition to ongoing, in-text references to claim forms and related on-the-job issues, UNDERSTANDING HEALTH INSURANCE, 12th Edition gives readers practice completing actual CMS-1500 claim forms by hand and online using easy-to-follow instructions.
  • Contemporary Coding: Exhaustive CPT and ICD-10 coverage outpaces competing health insurance texts with the latest coding manual information, numerous examples and skill-building exercises, and detailed explanations that prepare students for upcoming changes while building confidence with new requirements.
  • 59-day free trial of Encoder Pro.com—Expert™ from Optum lets students look up codes and descriptions quickly and with greater accuracy.

About the Contributor

  • Michelle A. Green

    Mount Wachusett Community College, Gardner, Massachusetts R Bio: Michelle A. Green, MPS, RHIA, FAHIMA, CPC is an Adjunct Professor in the Health Information Management Department at Mount Wachusett Community College, Gardner, Massachusetts. Ms. Green has also held the position of SUNY Distinguished Teaching Professor in the Physical and Life Sciences Department at the State University of New York, College of Technology, Alfred, from 1984 through 2016. An active member of the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA), Ms. Green has been recognized both for her excellence in teaching and for her significant contributions to the Health Information Management profession. She has earned numerous awards, including 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, and the FORE Triumph Educator Award from the AHIMA. Ms. Green is a Registered Health Information Administrator (RHIA), a Fellow of the American Health Information Management Association (FAHIMA), and a Certified Procedural Coder (CPC). She earned a BS from Daemen College and an MPS degree from Alfred University. Ms. Green has authored three successful books related to coding and health information.

Table of Contents

1. Health Insurance Specialist Career.
2. Introduction to Health Insurance.
3. Managed Healthcare.
4. Processing an Insurance Claim.
5. Legal and Regulatory Issues.
6. ICD-10-CM Coding.
7. CPT Coding.
8. HCPCS Level II Coding.
9. CMS Reimbursement Methodologies.
10. Coding for Medical Necessity.
11. Essential CMS-1500 Claim Instructions.
12. Commercial Insurance.
13. Blue Cross Blue Shield.
14. Medicare.
15. Medicaid.
17. Workers' Compensation.

New to this Edition

  • Expanded EMR: Added coverage of Electronic Medical Records includes more workbook problems for better context and clarity.
  • All-New Coding: Completely revised according to 2014's new ICD-10 code sets, UNDERSTANDING HEALTH INSURANCE, 12th Edition also presents the former ICD-9 codes as a legacy classification system.
  • Interactive Learning: The hands-on coding cases, games, and quizzing available in CourseMate and in our online resources help students understand concepts and master skills faster than book learning alone.
  • Revised Claim Forms: New CMS-1500 standardized forms appear throughout the text for practice with manual insurance claims, while the included SimClaim™ practice software trial familiarizes readers with the electronic version of this commonly used claim form.

Alternate Formats

Choose the Format that Best Fits Your Student's Budget and Course Goals

  • Book Only
    ISBN-10: 1285737598  | ISBN-13: 9781285737591
    Price = $141.00
  • MindTap 2 Terms (12 Months) + Bound Book
    ISBN-10:  130542767X | ISBN-13:  9781305427679
    Price = $151.00