Healthcare Insurance Coding, Billing, and Reimbursement

Introduction: In order to properly code a bill for medical necessity, it is important to understand different plans and the requirements for billing each. It is true that they all use the ICD-10-CM diagnosis coding system, the CPT procedure coding system, and the CMS-1500 form, but each type of carrier has certain requirements for a clean bill.

Tasks: Create a billing manual constructed of summaries of each type of insurance. Include the major requirements for billing for each type. Note inpatient or outpatient differences where appropriate. Explain how to determine from the patient which type they subscribe to.