Karen Smiley, CPC, is a certified coding expert in physician and out-patient reimbursement with an extensive background as a coder, auditor, and accounts receivable manager.

Introduction 1

Part 1 Getting to Know Medical Billing and Coding 5

Chapter 1 Dipping Your Toes into Medical Billing and Coding 7

Chapter 2 Exploring the Billing and Coding Professions 17

Chapter 3 Weighing Your Employment Options 31

Part 2 Boning Up on the Need-to-Knows of Your Profession 43

Chapter 4 Compliance Understanding the Rules 45

Chapter 5 Not-So-Strange Bedfellows Medical Terminology and Medical Necessity 61

Chapter 6 Getting to Know the Payers 87

Part 3 Becoming a Professional Getting Certified 105

Chapter 7 Your Basic Certification Options, Courtesy of the AAPC and AHIMA 107

Chapter 8 The Path to Certification Finding a Study Program 121

Chapter 9 Signing Up and Preparing for the Certification Exam 141

Chapter 10 Adding Street Cred Specialty Certifications and Continuing Ed 161

Part 4 Dealing and Succeeding with Nitty-Gritty On-the-Job Details 173

Chapter 11 Processing a Run-of-the-Mill Claim An Overview 175

Chapter 12 Homing In on How to Prepare an Error-Free Claim 193

Chapter 13 From Clearinghouse to Accounts Receivable to Money in the Pocket 211

Chapter 14 Handling Disputes and Appeals 223

Chapter 15 Keeping Up with the Rest of the World 245

Part 5 Working with Stakeholders 253

Chapter 16 Dealing with Commercial Insurance Claims 255

Chapter 17 Caring about Medicare and Medicaid 267

Chapter 18 Coding Ethics Being an Advocate for Your Employer 281

Part 6 The Part of Tens 297

Chapter 19 Ten Billing and Coding Mistakes and How to Avoid Them 299

Chapter 20 Ten Acronyms to Burn into Your Brain 305

Chapter 21 Ten (Plus One) Tips from Billing and Coding Pros 311

Glossary 317

Index 325