- Features completely updated information that reflects the many changes in the insurance industry. - Contains a new chapter on UB-92 insurance billing for hospitals and outpatient facilities. - Includes a new appendix, Quick Guide to HIPAA for the Physician's Office, to provide a basic overview of the important HIPAA-related information necessary on the job.

Adjusting liability insurance claims requires skill, patience, knowledge of insurance, basic knowledge of tort and contract law, and knowledge and experience as an investigator. The liability claims adjuster is faced with the following basic obligations:1.To understand the law of torts as applied in the state where the adjuster works.2.To understand the law of contracts as applied in the state where the adjuster works.3.To understand sufficient medical terminology to be able to evaluate claims of injury.4.To understand the costs to repair or replace damaged real or personal property.5.To understand how to read and apply the terms and conditions of a liability insurance policy.6.To understand how to thoroughly investigate all claims assigned.7.To conduct an investigation of every claim assigned fairly and in good faith with an intent to find coverage for the loss presented by the insured.8.To understand how to analyze the insurance coverage and apply the facts established by the adjuster's thorough investigation to the policy wording.9.To be able to negotiate with claimants and lawyers to resolve bodily injury or property damage claims.10.To pay promptly all claims the insurer owes under the contract.11.To resist, and not pay, all claims the insurer does not owe under the contract of insurance. In the United States, the average adjuster is a 22-year-old female graduate of a liberal arts college who has little or no training sufficient to allow her to fulfill the obligations imposed on her as a representative of an insurer. Much to the chagrin of insurance claims professionals, some modern insurance companies simply hire a person to be an adjuster, provide no training, and send them out to deal with the public with only the assistance of a claims supervisor who may only have two years-experience.This Compact Book of Adjusting Liability Claims- Second Edition is designed to provide the new adjuster with a basic grounding in what is needed to become a competent and effective insurance adjuster. It also works as a refresher for the experienced adjuster.

Legal Precedence at the time when I was adjusting claims in India was not a common consideration. It took me almost six years to get to a stage where I could understand and appreciate the basic concepts underlying legal terms since immigrating to Canada in 2012. It has been a roller coaster ride for me, both scary and enthralling at the same time. Luckily, I had great company all through my journey. That's what inspired me to write this book. It is my attempt to provide a basic understanding of the legal concepts used in handling insurance claims, from an insurance adjuster's perspective. I have tried to tone down these concepts to simple terms, that could be easily followed by anyone not pertaining to the profession of law. I have discussed the day to day concepts, such as Final Release, Reservation of Rights Letter and similar other terms encountered by a claims professional while adjusting insurance claims....

This combination textbook and workbook, explains each phase of the medical claim cycle, from the time the patient calls for an appointment until the financial transaction for the encounter is completed. Coverage includes types of insurance payers, basic coding and billing rules, and standard requirements for outpatient billing using the CMS-1500 claim form. It also emphasizes legal aspects related to each level of the medical claim cycle and the importance of the medical office employee, showing their responsibility for and impact on successful reimbursement. 3 separate chapters offer coverage of the basic concepts of medical coding.A comprehensive overview of the CMS-1500 claim form with step-by-step guidelines and illustrations thoroughly covers reimbursement issues and explains the billing process.Includes detailed information on various insurance payers and plans including Medicare, government medical plans, disability plans, private indemnity plans, and managed care.Stop & Review sections illustrate how the concepts presented in each chapter relate to real-life billing situations.Sidebars and Examples highlight key concepts and information related to the core text lesson.A companion CD-ROM contains sample patient and insurance information that readers can use to practice completing the accompanying CMS-1500 claim form, as well as a demonstration of Altapoint practice management software. Features completely updated information that reflects the many changes in the insurance industry.Contains a new chapter on UB-92 insurance billing for hospitals and outpatient facilities.Includes a new appendix, Quick Guide to HIPAA for the Physician's Office, to provide a basic overview of the important HIPAA-related information necessary on the job.