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Knowledge of medical coding and billing is key for any health science student pursuing a career in medical documentation. Because of this, you need lessons to introduce these concepts, and activities to reinforce the information.
To help you teach these important topics to your students, we’ve put together a list of lesson ideas!
The six best medical coding and billing lessons are:
Health insurance basics
Duties related to patient health insurance
The types of medical coding
Reimbursements & insurance payments
Legal issue pertaining to insurance, coding, & billing
Let's dive in!
1. Health Insurance Basics
Lesson Type: Class Discussion
Before jumping directly into coding and billing, it’s important to talk about health insurance and how it relates to coding and billing.
Many high school students have limited knowledge of health insurance, especially in relation to health care professions.
To get students off on the right foot, start with a classroom discussion on health insurance itself.
First, ask students to list things that can go wrong with the human body, such as illnesses and injuries. You can either record these on the board at the front of your classroom or just ask students to write down their ideas.
Then explain how health insurance works to cover many of the costs for those illnesses and injuries. You can really get the discussion going by asking students if they think health insurance is a good idea.
Encourage them to share their thoughts on both the pros and cons of having health insurance.
Making this lesson relatable will get your students more invested in learning about health insurance from the health care providers’ shoes!
2. Duties Related to Patient Health Insurance
Lesson Type: Lecture
Once your students have the basics of health insurance down, it’s time to dive into the details.
Focus on the role of medical billing specialists when talking to patients about insurance. Cover details such as premiums, deductibles, co-payments, patient insurance eligibility, and pre-authorization, among other topics.
If you have the time, it’s a great idea to include additional information about government-funded health insurance programs such as Medicare and Medicaid. Knowing about these programs and the differences between them will be crucial once your students are working in the field.
During this lecture, give your students plenty of opportunities to ask clarifying questions. This lesson will be a springboard into the ones that follow!
3. The Types of Medical Coding
Lesson Type:Lecture with Class Interaction and Scenarios
Once you’ve gotten through the lessons on insurance, you’re ready to get into the nitty gritty of how medical offices use codes. Start with the basics such as general coding guidelines, information about official coding manuals, and the different types of medical codes — diagnostic and procedural.
Then transition into the specifics of diagnostic coding and the importance of accuracy when it comes to diagnostic coding. To add some classroom interaction, you can have students review the International Classification of Diseases (ICD-10-CM) code set as you highlight what is included in the two volumes.
Circle back to your previous lessons and explain how diagnostic codes help during the insurance claims process.
Once you’ve gone over diagnostic coding, introduce procedural coding. Start by explaining how procedural coding relates to diagnostic coding to give your students the full picture.
Then, discuss how insurance carriers use procedural codes to determine reimbursement for the patient. As with diagnostic coding, you can have your students review the CPT-4 and HCPCS as you highlight what is included in each.
Round out the lesson by discussing how important it is to follow the appropriate steps to provide codes for insurance carriers. You can do this by giving a scenario of when a carrier may downcode a procedure if the codes given are too vague. Emphasize that that could result in the medical office losing money, and potential repercussions for the health care worker!
4. Claim Forms
Lesson Type: Lecture & Class Activity
Now that your students have learned the ins-and-outs of medical coding, you’re ready to talk about claims and billing.
Part of this lesson will involve students completing tasks as you walk through the steps of filling out a claim form.
Start with explaining the purpose of a claim form and the importance of a clean claim. Then pass out example claim forms for your students to reference as you talk about the different parts of the form.
This will be a process to get through, but explaining each block on the form is crucial to ensure your students understand it.
Once you’ve gone over the details, instruct students to practice filling out the claim form based on specific criteria you give them. When you do this, you will reinforce the importance of accurate coding.
After your class has completed the claim form activity, put your lecturing cap back on and talk about how claims are processed by insurance carriers. Make sure you discuss the different outcomes that can happen to a claim, such as unpaid claims, returned claims, and denied claims.
This will give your students an idea of the many scenarios they could encounter when it comes to working with insurance and claims.
5. Reimbursements & Insurance Payments
Lesson Type: Lecture & Class Activity
Now that your students understand submitting claims, it’s time to talk about reimbursement and insurance payments (i.e. billing)!
Start out by explaining the four main methods of insurance reimbursement:
Prospective Payment System (PPS)
Then transition to the procedure for applying insurance payments. This is a perfect time to have your students practice filling out a patient ledger and day sheet in addition to the claim form they’ve already used.
As with the previous lesson, instruct your students to fill out these forms based on criteria you provide.
By having students complete this hands-on activity, you’re reinforcing the importance of entering clear, accurate information because if something is entered incorrectly, there could be repercussions.
6. Legal Issues Pertaining to Insurance, Coding, & Billing
Lesson Type: Lecture
Wrap up your billing and coding lessons by discussing legal issues a medical assistant must know during the coding and billing process.
This is the perfect time to highlight the importance of the Health Insurance Portability and Accountability Act (HIPAA) in relation to the insurance claims process.
Your students most likely already have a general understanding of HIPAA, but providing specifics of how it impacts their work with billing and coding is essential.
You should also spend time discussing the different types of fraud related to insurance, coding, and billing. These include:
Upcoding, or coding to a level higher than the service performed
Unbundling codes, or billing ‘bundled’ codes separately, when they should be billed together
Billing for a service never provided
Be sure to explain how a medical office assistant could be held responsible if a physician asks them to code a claim in a fraudulent way.
This may seem like a bad note to end your coding and billing lesson, but it will leave an exclamation point in your students’ minds.
Discussing the legalities of billing and coding ensures your students understand how important it is to be honest and accurate with all information during the process!
Teach Medical Coding and Billing to Your Students Today!
Now that you have ideas for teaching these skills to your students, what’s next?
You could spend time using these ideas to develop your own lesson plans and practice activities. Or you could try a curriculum that has everything you need to incorporate into your classes!
HealthCenter21 is a digital health science curriculum that includes a full Insurance and Coding module of lessons, activities, and resources dedicated to helping you teach insurance, coding, and claims.
Along with ready-to-use lesson plans, you will have access to presentations to support your lectures, digital lessons for students to complete at their own pace, and skills checklists to keep tabs on how your students are doing.