Insurance and Coding

Insurance and Coding This module provides an overview of medical insurance, billing, and coding. Students are introduced to tasks and vocabulary used by office assistants working in healthcare settings. Students learn about government and managed care programs and the different types of coding and claims. They practice completing claim forms and gain an understanding of reimbursement and legal issues.

Phase 1: Explore

Activity: Discovering Codes

In this activity, students explore codes used in medical billing and coding. They draw on their experiences with illness and injury and then research codes to see how important it is to be accurate when coding and processing medical claims.

Phase 2: Learn & Practice

learn-and-practice

Unit 1: Insurance

In this unit, students are introduced to health insurance and industry-related vocabulary. Students also learn about office assistants' responsibilities for insurance and coding and how to apply managed care guidelines in medical offices.

Lessons

Introduction to Insurance
Types of Insurance
Managed Care Plans
The Assistant's Role
Referrals and Preauthorization

Unit 2: Government Programs

In this unit, students learn about government medical programs, including Medicare, Medicaid, and forms of insurance for the military. A lesson on workers' compensation is included in this Unit.

Lessons
  1. Medicare
  2. Medicaid
  3. Workers' Compensation
  4. Military Carriers

Unit 3: Coding

In this unit, students get an introduction to coding and the different codes, including diagnostic and procedural coding. Students identify the steps and guidelines involved in performing diagnostic coding.

Lessons
  1. Coding
  2. Introduction to Diagnostic Coding
  3. Performing Diagnostic Coding
  4. Procedural Coding

Unit 4: Claims

In this unit, students learn about claim forms, how to complete forms, and how claims forms are processed. They also learn about the types of reimbursement and how to obtain reimbursement for claims. Students learn about legal issues, including HIPPA, fraud, abuse, and the Medicare audit process.

Lessons

The Claim Form
Claims Processing
Reimbursement
Legal Issues

Phase 3: Reflect

reflect

Reflection Activity: Reflection Questions and Discussion

In this activity, students reflect on the importance of accuracy in insurance and coding, evaluate ethics in the coding industry, and analyze the strengths and areas of growth they bring to a job in insurance and coding.

Phase 4: Reinforce

reinforce-phase

Activity: Fill Out a Claim Form

In this activity, students take on the role of medical office assistant at a family practice. They will code a diagnosis and complete a claim form.

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