Understanding Health Insurance: A Guide to Billing and Reimbursement, 2025 Edition

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 health insurance 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 billing data and patient histories. Auto-graded features provide students with instant feedback.

Review questions include multiple choice questions to help accurately assess student comprehension of chapter content. Additional questions focus on gauging understanding of key concepts and applications such as practice in calculating insurance or Medicare payments, co-payments and coinsurance. To gain valuable hands-on practice, students can complete coding exercises throughout Chapters 6–8. Answers to exercises are available in the solutions and answer guide.

The text includes updated health insurance, medical billing and reimbursement concepts. New content covers artificial intelligence, managed care contracts, risk adjustment methodologies and payment models, national standard formats for claims submission, the Medicare drug price negotiation program, Office of the National Coordination for Health Information Technology and it's eHealth Exchange, Health Information Technology for Economic Clinical Health Act, Medicare [inpatient] code edition, new technology add-on payments and appeals and denials in individual health insurance chapters.

Instructions for completing insurance claims within Chapters 11–17 have been carefully updated. Revisions reflect the latest requirements to prepare students to seamlessly transition their skills from academic to professional environments.

Chapters 6–16 include new and revised ICD-10-CM, HCPCS Level II and CPT® codes. All content, related exercises in Chapters 6–8 and chapter reviews reflect the latest coding changes and guidelines and their impact on assigning codes.