Hospital Billing from A to Z

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Hospital Billing from A to Z

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Hospital Billing from A to Z

Charlotte L. Kohler, RN, CPA, CVA, CRCE-I, CPC, ACS, CHBC

With Kohler HealthCare Consulting, Inc., associates
Catherine Clark, CPC, CRCE-I
Darrin Cornwell, CRCS-I
Janet Ellis, RN, BSN, MS
Dawn Doll Homer, CPC, CRCS-I, CDC
Daria Malan, RN, LNHA, MBA, RAC-CT®
John Ninos, MS, MT(ASCP), CCS
Robin Stover, RN, BSBA, CPC, CPC-H, CMAS
Deanna Turner, MBA, CPOC, CPC, CPC-I, CSSGB
Susan Walberg, JD, MPA, CHC


Hospital billing departments are known by various names, but their staff all experience the same problems understanding and complying with Medicare’s many billing requirements.

Hospital Billing From A to Z is a comprehensive, user-friendly guide to hospital billing requirements, with particular emphasis on Medicare. This valuable resource will help hospital billers understand how compliance, external audits, and cost-cutting initiatives affect the billing process.

Beginning with 2-Midnight Rule and Inpatient Admission Criteria and ending with Zone Program Integrity Contractors, this book addresses 88 topics in alphabetical order, including the following:

  • Correct Coding Initiative
  • CPT®, HCPCS, Condition Codes, Occurrence Codes, Occurrence Span Codes, Revenue Codes, and Value Codes
  • Critical Access Hospitals
  • Deductibles, Copayments, and Coinsurance
  • Denials, Appeals, and Reconsideration Requirements
  • Dialysis and DME Billing in Hospitals
  • Hospital-Issued Notice of Noncoverage
  • Laboratory Billing and Fee Schedule
  • Local and National Coverage Determinations
  • Medically Unlikely Edits and Outpatient Code Editor
  • Medicare Advantage Plans
  • Medicare Beneficiary Numbers and National Provider Identifier
  • Medicare Part A and Part B
  • No-Pay Claims
  • Observation Services
  • Outlier Payments
  • Present on Admission
  • Rejected and Returned Claims
  • UB-04 Form Definitions


Who should read this book?

  • Finance and reimbursement staff
  • Chargemaster staff
  • Billers and coders
  • HIM staff
  • Clinical department staff
  • Revenue managers
  • Compliance officers and auditors
  • Registration staff
  • Fiscal intermediary staff
  • Healthcare attorneys, consultants, and CPAs
  • Legal department staff


About the author

Charlotte L. Kohler, RN, CPA, CVA, CRCE-I, CPC, ACS, CHBC, the president of Kohler Healthcare Consulting, Inc., has more than 30 years of healthcare experience, including reimbursement compliance and fraud and abuse litigation support.

Her work in billing and reimbursement has included:

  • Analysis of billing methods and concepts to recommend appropriate coding and billing techniques for Forms 1500 and UB-04
  • Hospital process improvements, including forms design and training
  • Analysis of computer system capabilities for required statistical and financial data
  • Reimbursement and billing analysis to assist with operational changes, service development, litigation support, and third-party investigations
  • Statistical analysis of billing errors and problems for testimony


Published: August 2014