Part of Unit: Health Care Insurance Coverage
Lesson Plan Overview / Details
In this lesson the student will be exposed to and given the opportunity to demonstrate their understanding of a patient encounter form, a health and physical (H & P) form, a patient history form, and various insurance forms.
The Life Cycle of an Insurance Reimbursement
- 1 block period
- 120 Minutes
California Career and Technical Education Standards
- HSMT.E.E2.1 Understand the collection and formatting of information by using facility protoc...
- HSMT.E.E2.2 Use medical terminology appropriate to therapeutic services to interpret and com...
- HSMT.E.E4.2 Understand the process for reporting patients’ and clients’ responses to adminis...
- HSMT.E.E4.3 Know the process for assessing patients’ and clients’ responses to administered ...
- HSMT.E.E5.1 Use the appropriate evaluation tools to assess patients and clients.
- HSMT.E.E5.2 Understand the process for revising or creating modifications to treatment plans...
Objectives and Goals
- At the completion of this lesson the student will demonstrate their ability to comprehend the standard medical terminology used.
- Understand and be aware of the interaction of the patient's account directly impacting that patient's relationship to the doctor and his practice specifically based upon the insurance reimbursement
- Learn and understand how to process a standard insurance form and expedite payment of a patients account.
Activities in this Lesson
- Blank HCFA (Health Care Financing Administration)form - Hooks / Set
As students enter my classroom have the classroom semi darkened. On their desks, place a folder containing a copy of a blank HCFA (Health Care Financing Administration) form as well as copies of medical health physical forms, standard medical chief complaint forms, and a dental form for comparison.
As the bell rings, begin a clip of John Grisham's "The Rainmaker" 1997, based upon the novel of the same name. This particular segment is of the courtroom where the insurance company adjuster is telling the mother of the young man who has just died, that she is " stupid, stupid, stupid" for resubmitting the insurance papers repeatidly even though the company continues to deny the claims.
The use of this particular segment will attract the students attention by focusing on the negative connotations commonly placed upon the insurance companies. Use this powerful opening to transition the student's curiosity into instructive matierial that will allow them to approach the subject of insurance processing factually and practically.
- YouTube- The Rainmaker.mp4 [ Watch Video ] [ Download Original Video ] WOW !! How many have of you have heard your parents say something derogatory about the insurance company that they have? How many of you even know what insurance company you have? Do you have a card that you carry in your wallet? Let's go back to the film clip one more time....now let's look at the first form in your packet. Would the mother in the film truly have been "stupid,stupid, stupid?"...perhaps not. Let us consider that she has an insurance card, then insurance forms...she fills in the blanks...just as we will be doing in a later lesson with one of our patients. *Give students a brief period of time to discuss any experiences they may have had with hospitals or large medical bills etc.
- HCFA (Health Care Financing Administration)1500_fill.jpg [ View Image ] [ Download Original ] This first form is a standard encounter form that is used by all physicians to bill for their services in their offices. Almost done entirely electronically.
- hospital form.jpg [ View Image ] [ Download Original ] This next form in your packet is representative of a standard hospital billing encounter form. It is important to remember that this type of billing form is used to bill for ONLY the facility charges. Each actual special 'person' or entity that serves the patient will be billing for that special department ...
- dental form.jpg [ View Image ] [ Download Original ] This next form that you see is obviously different...that difference is what? yes, it has teeth on it ...therefore it would be used by....that is correct, it would be used by dentists. Again, although almost all offices medical and dental transmit there offices electronically...they still have to enter the information in this form format for it to transmit.
- history and physical.jpg [ View Image ] [ Download Original ] This last form that you have is representative of the information that your physician has you complete...and then the office translates that information onto the forms for future submission. We will be completing insurance forms in the future as we study the codes that are representative of the services that the providers provide to the patients.
- Assessment Types:
Please take out the History and Physical from. Fill in the blanks as a patient would. Do NOT use any authentic identifying information. This exercise is for classroom practice only. All information is to be 'made up'.
After you have your History and Physical completed, please bring it to my desk for review.
*At this time I would go back to my desk and let the students try to fill in the forms to the best of their abilities. Often time students are ignorant of very basic facts that make up the day to day workings of life. I do NOT answer any questions yet....I give the students 15-20 mins. Then, as they come to me we are generally close to the end of the period and they are beginning to understand how daunting it must have been for the mother of the young man in the movie...which leads again into tomorrow. I ask them to put their true name on their folders, put their papers in their folders and turn them in for tomorrow.