Answer the following question in regards to Ethical Coding Standards for coders
ID: 442197 • Letter: A
Question
Answer the following question in regards to Ethical Coding Standards for coders in the Health Information Department. The in-service shall include the AHIMA ethical coding standards.
1. What is the purpose of the in-service session?
2. Provide examples of what coders should do to comply with each ethical coding standard.
4. What is the impact of not following ethical coding standards?
3. What is the relationship between the Office of Inspector General (OIG) and ethical coding standards?
4. What action should a coder take when reporting unethical coding violations?
5. How should the HIM manager monitor the coders work to ensure ethical standards are in compliance?
6. What are resources coders can use as they perform daily coding functions?
7. How can coders help improve compliance?
Explanation / Answer
Q - 1) What is the purpose of the in-service session?
Ans - 1 . The in - service session serves various purpose. Some of it are as follows :
a) Promotes high standards of HIM practise.
b) Identifies the core values on which the HIM mission is based.
c) Summarizes broad ethical principles that reflect the profession's core values.
d) Provides ethical principles by which the general public can hold the HIM professional accountable.
e) Mentors practitioners new to the field to HIM's mission, values and ethical principles.
Q-2) Provide examples of what coders should do to comply with each ethical coding standards.
Ans - 2 . The coders should advocate, uphold and defend the individual's right to privacy and the doctrine of confidentiality in the use and disclosure of information.
Refuse to participate in or conceal unethical practises or procedures and report such practises.
Preserve, protect and secure personal health information in any form and medium and hold in the highest regards health information and other information of a confidential nature obtained in an official capacity, taking into account the applicable statues and regulations.
Q-3) What is the impact of not following ethical coding standards?
Ans - 3 . The major consequence of not following ethical coding standards will be that criminal law would be applicable and those resonsible for violating the ethical coding standards would be punished.
Q-4) What is the relationship between the Office of Inspector General (OIG) and ethical coding standards?
Ans - 4 ) When medical billing and coding professionals speak of the Office of Inspector General (OIG), it is usually in reference to a possible audit or a compliance program. Most likely it is also related to the Medicare and Medicaid programs or the Health Insurance Portability and Accountability Act (HIPAA).
To make it easier for medical billing and coding professionals to stay within federal operating guidelines, the OIG has released a memorandum oncompliance program guidance specifically for third-party medical billing and coding professionals. The OIG provides a basic template for billing and coding professionals to follow and therefore avoid any legal trouble associated with fraud and abuse in the Medicare and Medicaid programs.
Billing and coding professionals can adapt these OIG suggestions to their own private practice, a small business, or a large company.
The following seven recommended compliance program steps are provided by the OIG, and directly based on Federal Sentencing Guidelines to punish those convicted of federal crimes:
a). Develop and circulate a written document that covers standards of conduct and specifically addresses the potential of fraud in vulnerable areas such as:
b). Designate someone who is in charge of monitoring and operating these standards of conduct in this compliance program.
c). Make sure to conduct team or individual training sessions that keep all necessary employees up to date on the most current developments with the OIG.
d). Create and maintain a way of receiving tips or reports regarding any violations of the standards of conduct. Make sure those providing information can do so anonymously.
e). Develop a response plan to investigate reports of violations of the standards of conduct. Accordingly, develop a response plan to punish violators.
Q-5) What action should a coder take when reporting unethical coding violations?
Ans - 5 ) If any employee have knowledge of, or in good faith, suspect any wrongdoing in the documenting, coding, or billing for services, equipment, or supplies; in the organization’s financial practices; involving any violation of any law or regulation; or involving a violation of ethical coding standard, they should promptly report it so that an investigation can be conducted and appropriate action taken. There are many ways to report suspected improper conduct. In most cases, any concerns should be brought to the attention of a supervisor. However, if this does not result in appropriate action, or if an employee is uncomfortable discussing these issues with their supervisor, they should take their concerns to another member of management, or use the reporting methods available through the facility compliance programs. Failure to report any known illegal conduct can have serious consequences.
Q-6) How should the HIM manager monitor the coders work to ensure ethical standards are in compliance?
HIM Manager performing the query function should follow their healthcare entity’s internal policies related to documentation, querying, coding, and compliance, keeping in mind that data accuracy and integrity are fundamental HIM values. Only diagnosis codes that are clearly and consistently supported by provider documentation should be assigned and reported. A query should be initiated when there is conflicting, incomplete, or ambiguous documentation in the health record or additional information is needed for correct assignment of the POA indicator.
Q - 7) What are resources coders can use as they perform daily coding functions?
Ans - 7) Medical coders might not decipher top-secret government codes, but their skills are critical to insurance companies, hospitals and health-care organizations. When a patient receives care from a provider, each procedure is documented, detailing what's wrong with the patient and what services were performed. Medical coders translate medical procedures into a standardized code so insurance companies can assess financial obligations and create invoices for services provided. Because there are so many illnesses, procedures and medical services, medical coders must research a large number of codes and understand basic medical terminology to perform their daily duties.