Welcome to Hospital Billing. This text/workbook introduces you to the basic concepts, knowledge, and skills you will need for a successful career in hospital billing. Health care continues to be one of the fastest growing industries in the United States. This growth is the result of the increased medical needs of an aging population, advances in technology, and the growing number of health practitioners. There is increasing need for health care administrative staff to support medical professionals in many capacities. One critical function in all health care settings is medical billing. Individuals who have an understanding of the revenue cycle and billing requirements in facilities are well prepared to handle these positions.

Patient account specialists in billing departments play important roles in the financial wellbeing of all health care facilities. Billing for services in health care is more complicated than in other industries. Government and private payers vary in payment for the same services, and health care providers deliver services to beneficiaries of several insurance companies at any one time. Patient account specialists in the hospital setting must be familiar with the rules and guidelines of Medicare in particular, as well as other health care plans, in order to submit correct claims for proper reimbursement. With an effective administrative staff, a hospital billing department receives maximum appropriate reimbursement for services provided.

Hospital billing is a challenging, interesting career, where you are compensated according to your level of skills and how effectively you put them to use. Those with the right combination of skills and abilities may have the opportunity to advance to management positions such as patient account managers or to positions such as outpatient or inpatient billing consultants. The more education the individual has, the more employment options and advancement opportunities are available. Individuals who have a firm understanding of the hospital billing process will find themselves well prepared to enter this ever-changing field.

Whether your course of study is medical assisting, medical insurance and billing, or health information technology, this text/workbook gives you the background, knowledge, and skills needed to successfully carry out billing-related duties in a facility setting.

Entry-level hospital billers must have a basic grasp of the following:

• The hospital billing flow
• Basic coding and payment systems
• The data elements required to complete the newly mandated hospital billing form (UB-04)
• The relationship of the paper UB-04 billing form to its electronic equivalent
• The way in which form-completion requirements vary depending on the type of facility, the medical insurance plan, and the inpatient/outpatient status
• Job performance in compliance with HIPAA privacy and best practices regulations

Hospital Billing 2e presents clear, straightforward coverage of these topics reinforced by extensive application material.

The three instructional parts of the text/workbook follow this sequence:

• The five chapters in Part 1, The Hospital Billing Environment, provide essential background about the health care environment, the hospital revenue cycle, medical insurance, and coding and payment systems.
• The ten chapters in Part 2, The UB-04 Claim Form, cover each major section of this complex claim form, explaining the important terms, the purpose, and the correct completion of the section.
• The two chapters in Part 3, Simulation, provide an opportunity for you to apply what you have learned as you complete inpatient and outpatient UB-04 claim forms, either by hand or by using the simulated UB-04 form available at the book's Online Learning Center.