Auditors Desk Reference formerly the Auditing and Denial Management Tool Kit helps you understand your denials, better manage your claims process, and learn what actions to take for a quicker turn around time on your reimbursement. From data collection and claims submission to payer inquiries and denial management you ll submit the right information up front and you ll know exactly how to correct denied claims so you spend less time and money resubmitting. Key Features and Benefits Optum Edge. Understand how to efficiently resolve denied claims and receive your money faster. Audit claims and processes to find the underlying problems that cause denials. Identify the root cause of denials and take action to prevent delayed or denied payment. Establish and maintain an effective denial management process. Quickly respond to payer inquiries and take the necessary corrective action. Optum Edge. Admittance Advice Remark code crosswalk and action alerts are included. Includes searchable CD. Access printable templates to help improve your appeal and resubmission processes. Easily search the contents of the manual for key topics. Understand what Medicare will cover when Medicare is the secondary payer. Comprehensive guidance to determining primary and secondary payer.

Auditors' Desk Reference 2013

Medical Books

INGENIX

Administration & Medicine Economics

Optum

ICD-9-CM Professional for Physicians 2013: International Classification of Diseases, 9th Revision, Clinical Modification, Sixth Edition: 1-2 (PHYSICIAN'S ICD-9-CM)

The 2013 ICD-9-CM Professional for Hospitals, Volumes 1, 2 &amp; 3 is loaded with innovative features and content to address regulatory changes and coding challenges. Optum experts study industry changes and trends while seeking feedback from coding professionals to ensure your code book provides accurate and up-to-date information in an easy-to-use, intuitive format. Remain a step ahead with a resource that s designed to enhance performance in your daily work. 
 Key Features and Benefits: ICD-10 Spotlight. Preview ICD-10 codes with the most frequently reported ICD-9-CM codes to learn as you work. 
 AHA s Coding Clinic and official coding guideline tips. Use citations to link to the official coding advice every coder in every health care setting must follow. 
 Symbols identify MCC and CC conditions. Ensure appropriate reimbursement by reporting patient severity correctly. Know when conditions are considered a complication or comorbidity, as well as which are major CCs that impact MS-DRG assignment. 
 Hospital-acquired condition (HAC) alerts. Know which conditions, when not present upon admission, will not impact DRG assignment. 
 Adjunct procedure code alerts. Learn how to properly use ICD-9-CM procedure codes that provide additional information only and cannot be used alone. 
 Additional digit required symbols. Know when an additional fourth or fifth digit is required for code specificity and validity to avoid invalid code submissions (provided in Index and Tabular Section). 
 Diagnosis and Procedure Medicare Code Edit (MCE) alerts. Color-coding and symbols identify all major Medicare Code Edits (MCE) used to audit claims submitted under the inpatient prospective payment system (IPPS) for diagnosis, including unacceptable PDx, questionable admission PDx, age, sex, CC and MCC, and manifestation codes. Also MCEs related to valid OR procedures, non-covered, limited coverage, non-operating room, bilateral edits and sex edits. 
 Intuitive color-coded symbols and alerts. Identify critical coding and reimbursement issues quickly with alerts on the same page as the code you need. 
 Hallmark page design and features. Locate information quickly with a user-friendly page design, including dictionary-style headers, Quickflip color bleed tabs, and legend keys. 
 Illustrations and definitions. Gain in-depth understanding of anatomy and disease processes in relation to coding with clinically-oriented definitions and illustrations.

ICD-9-CM Professional for Hospitals - Volumes 1, 2, & 3--2013 Edition

ICD-9-CM Expert for Hospitals and Payers provides accurate and comprehensive coverage for diagnosis coding and reimbursement. Optum experts study industry changes and trends while seeking feedback from coding professionals to ensure your code book provides accurate and up-to-date information in an easy to use, intuitive format. Remain a step ahead with a resource that s designed to enhance performance in your daily work. Key features and benefits: 
ICD-10 Spotlight. Preview ICD-10 codes with the most frequently reported ICD-9-CM codes to learn as you work. 
 Present on admission (POA) indicator tutorial with source documentation table. Access additional explanation and examples to help simplify POA, plus official guidelines regarding use of information in the medical record. 
 Dx/MDC/DRG list. Enhance overall reimbursement and reduce potential fine risks with information concerning the MDC and MS-DRG that a specific principal Dx group is under in the new MS-DRG system. 
 10 Steps to Correct Coding. Receive step-by-step instructions to improve coding accuracy and more effectively use ICD-9-CM conventions. 
 Intuitive color-coded symbols and alerts. Identify critical coding and reimbursement issues quickly with alerts on the same page as the code you need. 
 Hallmark page design and features. Locate information quickly with a user-friendly page design, including dictionary-style headers, QuickflipTM color bleed tabs, and legend keys.

ICD-9-CM 2013 Expert for Hospitals and Payers Volumes 1, 2, & 3

Focus your ICD-10-CM training without learning the entire code set. By mapping the most frequently used ICD-9-CM codes for your practice or facility to their corresponding most current (2013 draft) ICD-10-CM codes you can identify areas needing increased documentation and evaluate how additional specificity may impact your revenue. The higher degree of specificity in the ICD-10-CM code set is going to require more documentation and more coding precision This book was created to simplify your transition and get your office or facility ready for future documentation and coding needs. Key Features and Benefits: Perform impact analysis to identify and focus on high priority coding issues. Using the ICD-9-CM codes you already know as your guide, you'll be able to quickly identify the ICD-10-CM codes that are pertinent to your office or facility and zero-in on codes to focus on for training and system transition. Links ICD-9-CM codes to all valid ICD-10-CM alternatives. Convenient look-up tool for verifying code choices in the new code system. Jump-start your implementation plan. Start improving documentation habits now in preparation for increased documentation requirements under ICD-10.  Must-have resource to update your office's coding and billing tools. Choose the right codes to convert super bills, forms, reports, and EHRs/PHRs that meet your specific clinical and coding criteria. Software validation. Use this mapping tool to verify software accuracy, evaluate new software, and assist in conversion planning. Easy-to-use table format. Lists ICD-9-CM codes with titles and the corresponding ICD-10-CM codes with titles.

ICD-10-CM 2013 Mapping

2013 Medical Billing Basics offers comprehensive, entry level education for beginning coders and billers in the office or classroom. This book is designed to allow the user to understand and master the basic skills needed to be an effective coder or biller. Key Features and Benefits Optum Edge Complete foundation for coding and billing. Broad overview of coding, payers, and the reimbursement process for the entry level coder or billing professional. Optum Edge Simple coding scenarios. Simple coding scenarios turn the abstract world of medical reimbursement into real case studies. Optum Edge Understandable coding basics. Helps users learn basic physician and hospital coding and billing. Updated code sets. Includes the latest CPT, HCPCS Level II, and ICD-9-CM codes. Insurance and payer background. Takes the confusion out of the alphabet soup of different types of insurance and payers. Effective supportive material. Illustrations and coding scenarios ease understanding and put information into context. Developed by coding educators. Designed to help offices grow and their staff prepare for certification and accreditation. CPT is a registered trademark of the American Medical Association.

Optum Learning: Medical Billing Basics 2013

2013 Understanding Modifiers uses actual medical records to outline in detail how to document services and apply the correct modifiers. The book was developed as an educational tool for physicians and their staff as well as billers and coders of hospital outpatient services and ASC services. Key Features and Benefits
 Optum Edge Educational format. Easy to use format for every experience level, for use in the classroom or on the job.
 Optum Edge World Wide Web resources. Supplies all of the up to date links a coder needs to find accurate modifier information online.
 Optum Edge Decision tree flow charts. Helps the coder choose the correct modifier when more than one could apply.
 Optum Edge Real life clinical examples. Helps reduce claim denials by supplying correctly used modifiers and completed CMS 1500 forms.
 Includes 2013 changes to modifiers and their guidelines.

Optum Learning: Understanding Modifiers 2013 (Coding and Reimbursement Educational)

2013 Understanding EM Coding gives you the basics on how to code evaluation and management. Many providers undercode these services, and therefore get reduced reimbursement, because they don't understand how to determine and document level of service. This instruction manual will help you code the highest level of service supported by the documentation and get the payment these services deserve. Key Features and Benefits Optum Edge. Includes the new 2013 changes to evaluation and management. Optum Edge. Clinical case studies. Train coders and doctors using real life case scenarios they can relate to.  Optum Edge. Self audit forms, including official CMS auditing form. Helps ensure documentation supports level of EM service coded to avoid claims denial. Optum Edge. Audit scenarios included. Helps users uncover areas of risk in their own organizations so that they can fix problems before a government audit.

Optum Learning: Understanding E/M Coding 2013 (Optum Learning: Coding & Reimbursement Educational)

Consolidate the coding process with the one-stop resource developed exclusively for those who code for ENT, allergy, and pulmonology. Co-produced with the American Academy of Otolaryngology Head and Neck Surgery AAO-HNS, this comprehensive guide includes 2013 CPT and ICD-9-CM code sets specific to ENT, allergy, and pulmonology in an easy-to-use, one-page format. Each page has the CPT code with its official description and a detailed illustration, as well as lay descriptions, coding tips, terminology, cross-coding, and national Medicare relative value units. Getting to the code information you need has never been so easy. Key Features and Benefits Illustrated one-page format. All the information you need is on one illustrated page, including lay descriptions, coding tips, terms, cross-coding, and Medicare RVUs and Pub. 100 references. Organized by CPT code. Essential procedures for ENT, allergy, and pulmonology are listed by CPT code, along with crosswalks to ICD-9-CM diagnosis, procedure, and anesthesia codes. Easily determine fees for your practice and reinforce consistency in the charges. National Medicare relative value units for surgery codes and most diagnostic procedures are included. Avoid claim denials and or audits. Medicare payer information provides the references to Pub. 100 guidelines, follow-up days, and assistant-at-surgery. CPT is a registered trademark of the American Medical Association.

Coding Companion for ENT/ Allergy/ Pulmonology 2013

Consolidate the coding process with the one-stop resource developed exclusively for those who code for general surgery and gastroenterology. This comprehensive guide includes 2013 CPT and ICD-9-CM code sets specific to general surgery and gastroenterology in an easy-to-use, one-page format. Each page has the CPT code with its official description and a detailed illustration, as well as lay descriptions, coding tips, terminology, cross-coding, and national Medicare relative value units. Getting to the code information you need has never been so easy.
 Key Features and Benefits
 Illustrated one-page format. All the information you need is on one illustrated page, including lay descriptions, coding tips, terms, cross-coding, and Medicare RVUs and Pub. 100 references.
 Organized by CPT code. Essential procedures for general surgery and gastroenterology are listed by CPT code, along with crosswalks to ICD-9-CM diagnosis, procedure, and anesthesia codes.
 Easily determine fees for your practice and reinforce consistency in the charges. National Medicare relative value units for surgery codes and most diagnostic procedures are included.
 Avoid claim denials and or audits. Medicare payer information provides the references to Pub. 100 guidelines, follow-up days, and assistant-at-surgery.
 CPT is a registered trademark of the American Medical Association.

Coding Companion for General Surgery/ Gastroenterology 2013

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