Chapter 21: Ethical Issues in Health Information Management 21.1: Real-World Cas

Question

Chapter 21: Ethical Issues in Health Information Management 21.1: Real-World Case Kelly was a new coder who had never held an HIM job before. She had just graduated from college and passed her RHIT when she was hired by a local clinic and was so excited to start working. A few weeks later, her manager asked to meet with her. The manager closed the door and told Kelly that she wanted her to code charts for a particular procedure using two codes instead of one so the reimbursement would be higher. The manager then proceeded to divulge information that the clinic was struggling financially so anything extra would help. Kelly got the impression that if she did not comply they would let her go; and she really needed this job. Also, since it was her boss asking, she felt obligated to do as she was told. 21.1: Discussion Questions 1. What are the ethical issues associated with this case? o First, what the manager has ask Kelly to do is unethical and clearly fraudulent. The manager clearly knows what she has ask her to do is wrong. Unbundling codes or upcoding for higher reimbursement is an ethical issue. 2. Identify a few things the hospital can do to prevent the unethical behavior: o Organizations should create policies and practices that define, identify, and report ethical violations. o Organizations should “hire right” using pre-screening tools and behavioral based interview questions. o Finally, the organization should also develop an understanding of the importance of ethics violations by building the staffs understanding and how to report violations. 3. Discuss Ms. Brown’s potential ethical cultural shock by learning who she was and meeting family and friends: o a) Who she does not remember. Think in terms of religion and cultural bias or prejudices.

Explanation / Answer

1). The guidelines provided in the specific manual must be followed while coding in the medical facility. The knowledge of a medical assistant about correct diagnostic coding positively contributes to the legal and financial health of the practice. The term “upcoding” refers to a selected code that adds modifying information not present in the medical documentation in addition to the procedure or service that is actually rendered. Upcoding must be avoided because it can be considered as fraud or abuse if done consistently and may result in legal charges.

In the given case, the manager asked Kelly to practice "upcoding," which is an ethical and legal issue.  

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