Insupervising health information management, the coding function iscritical for planning and reimbursement. With the hospital underfinancial risk, coding faces ethical challenges, and more especiallythe hospital`s financial compensation. The administration isattracted to higher hospital`s reimbursement under Medicare.
Asa healthcare provider, we face an ethical challenge of applyingdiagnostic codes to enhance reimbursement. This activity is anillegal form of Medicare fraud as it fails to focus on the accuracyof coding and the complex guidelines involved in coding andreimbursement. The American Health Information ManagementAssociations recommends that the principles applied in ethical codingmust reflect professional conduct (AHIMA, 2011). Inaccurate reportingcontravenes ethical guidelines that consistently support healthdocumentation as applicable in the abstraction of health data.
Thepayment of consultancy fee measured as a percentage of the hospital’sMedicare reimbursement presents a form conflict of interest.Consultants perform the task in their interests to favor higherremuneration regardless of the quality of services offered. We shallseek to analyze previous work on the accuracy of consultants visitcoding. This process will assess if consultants correctly codeevaluation services in the hospital (McWay, 2013).
Theethical challenge is the action of avoiding detection of the codingscheme which is a form of fraud. Eliminating healthcare fraud isaddressed under the HCFA`s action plan that seeks to address measuresto curb these errors (Department of Health and Human Services, 2016).The challenge presents the critical principle of honesty of codingthat will reduce the fraudulent reimbursement to the hospital.Through the acquisition of commercial software, this hospital seeksto detect billing irregularities hence, curbing the avoidance ofdetection by coding scheme. In its health information management, thehospital aims to demonstrate that it practices medical recorddocumentation and relays accurate, ethical coding that supports theservices reported as reimbursement claims.
Departmentof Health and Human Services, Centers for Medicare and MedicaidServices. (2016). Medicarefraud and abuse: prevention, detection, and reporting. Retrievedfromhttp://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Fraud_and_Abuse.pdf
McWay,D. C. (2013). Today`shealth information management: An integrated approach.Cengage Learning.
AmericanHealth Information Management Association (AHIMA). (2011). Codeof Ethics.2011. Availableat http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024277.hcsp?dDocName=bok1_024277 (accessedJanuary 10, 2017)