Investigating Child Exploitation and Pornography or Medical Insurance Billing and Coding

Investigating Child Exploitation and Pornography: The Internet, Law and Forensic Science

Author: Monique Ferraro

Crime scenes associated with child sexual exploitation and trafficking in child pornography were once limited to physical locations such as school playgrounds, church vestibules, trusted neighbors' homes, camping trips and seedy darkly lit back rooms of adult bookstores. The explosion of Internet use has created a virtual hunting ground for sexual predators and has fueled a brisk, multi-billion dollar trade in the associated illicit material. Approximately half of the caseload in computer crimes units involves the computer assisted sexual exploitation of children. Despite the scale of this problem, or perhaps because of it, there are no published resources that bring together the complex mingling of disciplines and expertise required to put together a computer assisted child exploitation case.
This work fills this void, providing police, prosecutors and forensic examiners with the historical, legal, technical, and social background for the laws prohibiting child exploitation, in particular, child pornography. The book will become an indispensable resource for those involved in the investigation, prosecution and study of computer-assisted child sexual exploitation.

The book provides a history of child exploitation cases and studies, outlining the roles of technology in this type of crime and the evidence they can contain, and documenting new research performed by the authors. It details how successful undercover Internet operations are conducted, how the associated evidence is collected, and how to use the evidence to locate and apprehend the offender. The heart of this work is a legal section, detailing all of the legal issues that arise in Internet child exploitationcases. A forensic examination section presents evidentiary issues from a technical perspective and describes how to conduct a forensic examination of digital evidence gathered in the investigative and probative stages of a child exploitation case.
Citations to related documents are provided for readers who want to learn more about certain issues. Actual case examples from computer assisted child exploitation cases are explored, at all times protecting the privacy of the victims while providing enough detail to educate the reader.
In addition to providing guidance on the technical and legal aspects of child exploitation investigations, this work identifies and analyzes trends in this type of crime and helps readers understand the similarities and differences between child predators who take to the Internet and predators who do not. Data from the thirty Internet Crimes Against Children (ICAC) Task Forces are compiled and reported to provide a deeper understanding of the types of cases, types of offenders and the level of danger they pose to themselves, their victims, and investigating officers. Also, sex offender data from the Offices of Attorneys General in the United States and similar offices in foreign countries are gathered to increase the study sample size, establish controls, and expand the scope of the research to outside of the United States.

- The first comprehensive title in this subject area
- It will use real cases and examples of criminal behavior and the means to detect it.
- Provides guidelines for developing a Field Manual and a Checklist to supplement the investigation and legal process
- Establishes a reliable system and legal, procedural-backed protocol by which to conduct an online sexual investigation and collect evidence

Book review: Music Publishing or Human Factors in Project Management

Medical Insurance Billing and Coding: An Essentials Worktext

Author: Marilyn Fordney

Winner of the Text and Academic Authors Association's 2003 Textbook Excellence Award! This completely new full-color worktext presents all aspects of submitting, tracing, appealing, and transmitting claims for today's full range of health plans. Distilled from the comprehensive textbook, Fordney's Insurance Handbook for the Medical Office, this essentials text features a streamlined approach to key topics - including documentation in a medical office, Example boxes, colorful illustrations, and an appendix that uses color-coded payer icons to teach readers how to complete the HCFA-1500 form. Self-study workbook sections and practice exercises incorporated throughout the book make it easy to learn diagnostic coding, procedural coding, office and insurance collection strategies, Medicare considerations, and more. A companion CD-ROM and website offer additional practice and interactive learning opportunities!
• Combined text and workbook format keeps the content self-contained and easy to manage.
• Full-color format allows readers to identify colors and icons with individual payers, helping them to easily follow and learn specific payer rules and procedures.
• An appendix of block-by-block coverage, with full-color examples of the HCFA-1500 insurance claim form, facilitates understanding and effective learning.
• Photographs, quotes, and short biographies of real insurance billing specialists appear in each chapter, offering real-world perspectives on insurance billing.
• A separate chapter on documentation in the medical office is devoted to this critical topic.
• Exercise sections within the text encourage readers to stop and recall orapply what they've learned to help master key concepts.

Table of Contents:

Section I	Career and Professionalism
Chapter 1	A Career as an Insurance Billing Specialist	3
	Role and Responsibilities of the Insurance Billing Specialist	4
	Confidential Communication	14
	Professional Liability	18
Section II	Basics of Health Insurance
Chapter 2	Fundamentals of Health Insurance Coverage	31
	Health Insurance Contracts	32
	Legal Principles of Insurance	33
	Insurance Coverage and Benefits	38
	Physician/Patient Contract	39
	Types of Health Insurance Programs	44
Chapter 3	Source Documents and the Insurance Claim Cycle	53
	The Reimbursement Cycle	54
	Source Documents	54
Section III	Coding Insurance Claims
Chapter 4	Coding Diagnosis	73
	The Diagnostic Coding System	74
	International Classification of Diseases, 9th Revision, Clinical Modification	75
	Using the Diagnostic Codebook	76
	Basic Steps in Coding	89
	Coding Special Conditions	95
	Supplementary Classifications	95
	ICD-10-CM Diagnostic and Procedure Codes	96
Chapter 5	Coding Procedures Part I: Introduction and Evaluation and Management Services	107
	The Importance of Procedure Coding	108
	The Standard Code Set	108
	Introduction to the CPT Codebook	112
	Coding Evaluation and Management Services	113
Chapter 6	Coding Procedures Part II: Anesthesia, Surgery, Radiology, Pathology/Laboratory, and Medicine	133
	Coding Procedures and Services	134
	Coding Terminology	155
	Illegal or Unethical Coding	158
	Modifiers	158
Section IV	Claim Submission
Chapter 7	Documentation and the Medical Record	171
	The Medical Record	172
	The Documentation Process	174
	General Principles of Medical Record Documentation	177
	Components of a Medical Record	179
	Legalities of a Medical Record	182
	Data Storage	187
	Auditing a Medical Record	189
Chapter 8	The Health Insurance Claim Form: Completion and Submission	201
	The Insurance Billing Process	202
	The Health Insurance Claim Form	203
	Completion of Insurance Claim Forms	205
	Claim Form Requirements	206
	Computers in the Medical Office	215
Chapter 9	Fees: Private Insurance and Managed Care	233
	Private Insurance Versus Managed Care Plans	234
	Private Insurance	235
	Managed Care	244
Section V	Insurance Programs
Chapter 10	The Medicaid Program	275
	The Birth of Medicaid	276
	Medicaid Eligibility	277
	Medicaid Assistance Programs and Benefits	282
	Medicaid Managed Care	285
	Claim Procedures	285
	Medicaid Fraud Control	287
Chapter 11	The Medicare Program	297
	Medicare Policies and Regulations	298
	Medicare and Additional Insurance Programs	307
	Medicare Fraud and Abuse Protection	311
	Payment Fundamentals	313
	Health Care Financing Administration Common Procedure Coding System (HCPCS)	319
	Medicare Claim Submission	320
Chapter 12	The Tricare and Champva Programs	347
	Understanding Tricare Programs	348
	Tricare Standard	350
	Tricare Extra	358
	Tricare Prime	360
	Tricare Prime Remote Program	363
	Supplemental Health Care Program	364
	Other Tricare Health Benefits	364
	Champva Program	364
	Medical Records	367
	Claim Procedures	368
	Tricare/Champva and Other Insurance Coverage	370
Chapter 13	Workers' Compensation Coverage and Other Disability Programs	389
	Origins of Workers' Compensation	390
	Workers' Compensation Statutes	390
	Funding Workers' Compensation	392
	Second Injury Fund	392
	Workers' Compensation Requirements	392
	Types of Workers' Compensation Claims	396
	Common Workers' Compensation Terminology	397
	Employee's Claim for Workers' Compensation Benefits	399
	Medical Reports	400
	Testing and Treatment	407
	Legal Situations	407
	Claim Procedures	410
	Occupational Safety and Health Administration (OSHA)	413
	Other Disability Insurance Plans	414
Section VI	Receiving Payment and Problem Solving
Chapter 14	Patient Billing: Credit and Collection Practices	431
	Patient Payment Responsibility	432
	Itemized Statements	432
	Credit Arrangements	439
	The Collection Process	442
Chapter 15	Tracking Reimbursement	459
	Tracking Reimbursement	460
	Getting Paid	460
	Follow-up After Claim Submission	463
	Review and Appeal Process	468
	Follow-Up on Specific Claim Types	471
	Appendices
Appendix A	College Clinic--Medical Practice Simulation	481
Appendix B	College Clinic--Mock Fee Schedule	485
Appendix C	CPT Modifiers, Medicare's National HCPCS Level II Modifiers and Codes	497
Appendix D	HCFA-1500 Claim Form Block by Block Instructions and Insurance Templates	505
Appendix E	Glossary	559
Appendix F	College Clinic Form File	573
Appendix G	Student Software Challenge Installation and Operating Instructions	615
	Index	623