Medical Billing and Coding Demystified: A Self–Teaching Guide
By Marilyn Burgos, Donya Johnson and Jim Keogh Reviewed By Katherine Kay
(McGraw Hill Books – ISBN: 978–0–07147220–3))
This book covers the basics of medical billing and codingfor the person who wants a job in a medical practiceor hospital. It’s an informative book that covers the fundamentalsof billing, insurance, and the health industry.
A medical billing specialist is someone who ensures thedoctor gets paid. This person handles the paper work andforms that are submitted electronically to the insurancecompanies. There are detailed rules, policies and regulationsset by insurance companies, and government programs likeMedicare and Medicaid for submission of these forms.
Medical Billing and Coding Demystified covers the historyof insurance and medical economics,legalities, the importance of confidentialityof medical records, contracts and ethics.One chapter gives a mini–crash course onmedical terminology and how to deciphermedical words by understanding the suffixes,prefixes and roots of words.
The dynamics of a medical office are explainedwith an introduction to the medicalstaff, office procedures, and telephone etiquette.An explanation of various diagnosticprocedures and how these procedures arecoded using reference books like the InternationalClassification of Diseases ClinicalModification, ICD–9, is explained.
Insurance claims, which medical billingspecialists submit for reimbursements topay doctors, are covered. Coding using CurrentProcedural Terminology (CPT) manualsare also discussed.
Insurance plans from managed care to indemnity are explained—PPOs, POSs, HMOs, auto insurance for health, disability,workers’ compensation and liability. The book toucheson all the details, regulations, and various agencies involvedin health insurance and government insurance like Medicareand Medicaid.
The loss of time and the cost of errors on claims forms submittedto insurers are discussed in the book. The authors alsodiscuss the economics of premiums and interest and evenhow insurers will delay reimbursements to doctors, therebyaccruing more interest on the premiums collected from patients.
And, of course, ethics is an important part of the healthindustry. Just recently two doctors were arrested for fraudbecause they were billing insurers for claiming to see patientsthey never saw.
The book also mentions procedures of handling claim disputes and the appeal process. There’s a chapter about medicalbilling software; and the last chapter is about finding a job,writing resumes, cover letters, the job interview, potential jobpositions, and alternative career opportunities like consulting,writing or teaching.
The book contains big type and is a very easy reading experiencefor the reader. The book gives a general overview of thefield and does not go into great detail in any area. Each chapterfinishes up with a summary and a quiz of 10 questions.There is a 100– question final exam at the end of the book. Forthose young, inexperienced job seekers, the authors discussin the last chapter how to prepare for interviews,answer the phone and other elementaryinstructions.
The book is published by McGraw–Hilland is part of a popular series of books fromthe Demystified Series.
Entrepreneurs and known professionalsin the field have written better books on thesubject. Start Your Own Medical ClaimsBilling Service by Rob and Terry Adamsand Entrepreneur magazine are a good readoffering detailed facts and good medicalclaims billing resources, especially writtenfor the entrepreneur and home–based business.
Medical Billing and Coding Demystifiedsells itself on the cover by promising an “enlighteningway to learn” and a way to “findout what it takes to succeed.” It does notmake a return on its promises, however. There are a few goodsections about healthcare economics, the claims process,coding, and even the resume tips are market savvy.
But the problems of the book outweigh the positives. Thebook is replete with typos, not just one or two, but many. Sentencesdo not flow well. It’s as if three writers wrote withouta final smoothing over. Shortcuts are taken in the book by repeatingsentences, entire paragraphs, and quick paraphrases.
The book needs a good editor to give it a thorough cleaningup. I would not recommend this book to anyone because it’stoo sloppy, does not deliver on its promises, and because youcan find better material elsewhere. The book pretends to bethe answer to coding and billing, but it barely scratches thesurface and does not give comprehensive tips or resourcesabout where to find real facts and training.
