Ethical Coding Standards

As viewed by many HIM professionals Computer-assisted coding is a valuable tool for enhancing the effectiveness of coding and billing. CAC software scans medical documentation in the electronic health record (EHRs) using a natural language processing (NLP) engine, identifying key terminology and proposing codes for that specific treatment or service. Human coder then revised these codes. CAC can also investigate the background of key words to conclude whether they need coding.

In the daily changes of healthcare, health information technology is evolving rapidly. The generation of coding is making significant developments along the years as well. The 3M-encoder system provides number of essential options to coders in just one click. It provides sophisticated, easy-to-learn solution for accurate, complete, and compliant coding and grouping. Coders need to be acquainted with these references because they provide back up through the articles in each one of them. 3M Coding and Reimbursement System, 3M Coding Reference, and 3M Coding Reference plus have articles for coders to read and get answers to use the appropriate codes. (Prophet). Due

HIM Personnel play an important role in the Medicare system. Medicare has transitioned from “fee for service” to providing incentive payments for providers that issue high quality care at affordable prices. In order to achieve the “pay-for-quality” incentives hospitals and health care officials must improve their documentation processes. “If it isn’t documented, it wasn’t done” is more important than ever. It is the responsibility of the HIM professional to ensure the integrity of the patient chart. HIM professionals monitor the quality of documentation and ensure all clinical documentation is complete and accurate. HIM professionals are the key to identifying process problems while keeping in mind patient safety, quality of care, and revenue integrity. Medicare requires that hospitals report quality improvement measures in order to receive payments; HIM professionals can directly impact Medicare incentive payments. HIM professionals are directly involved with the Medicare Audit Improvement Act. The HIM professional collects health data that is subject to the audits; HIM professionals are the point of contact for responding to Medicare audit requests.

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

-Inpatient coders have certifications allowing them to work exclusively for hospitals or facilities. An expertise in medical record review is a must, along with an up to date status with coding rule changes, regulations and issues for medical coding, reimbursements and compliance under MS-DRG and Inpatient Prospective Payment Systems (IPPS). Coders should have experience as well as expert knowledge in abstracting information from medical records for ICD-9CM vol. 1-3, specialized payment in MS-DRG and IPPS.

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can leads to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

Ethics also plays a huge part in making a decision that yields a more positive outcome. Ethical Codes provides a framework and guidance for maintaining obligations to different stakeholders (Follari, 81).NAEYC and NEA both created a code of ethics. The national education association (NEA) code of ethics has two main principles: commitment to the student and commitment to the profession. NAEYC also developed a code of ethics with the intent to “give practitioners a research-based framework for making sound decisions in their work, especially when faced with ethical dilemmas” (Follari , 72). NAEYC code set a framework of professional responsibilities in four sections that address professional relationships that include: children, families, colleagues, and community and society; and in which each section is divided into ideal and principles. (NAECY 2011, pg 2)

In this case, CAC technology also provides a connection between EHR documentation and transcription systems. Primarily, CAC technology in a healthcare environment has rapidly and drastically changed the process in which medical coding in health-information management. This is handled for a better productivity and efficient workflow solution, including production monitoring, coding review, management reporting, computerization of coding and auditing. Clinical documentation is ensuring that it has routinely generated medical codes from computer assisted codes (CAC). In addition, CAC technology has enabled healthcare organizations to recognize the revenue-cycle process as they increase their requirements towards improved quality. The complete implementation of the CAC technology is essential when improving the main necessities towards patients, such as the efficiency, quality, productivity, and management of their care. Last but not least, CAC technology has produced one of the best strategies for the challenges that the HIM professionals face as coding becomes one of the most important aspects of transitioning to

What disciplinary action would you take if you found that a coder violated the Standards of Ethical Coding?

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly, or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can lead to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of the patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

Yes I agreed with the authors that a code of ethics should do more than establish minimum acceptable standards. As noted that, ethical behavior in any profession is about making correct judgment or decision that are based on established code of ethics. Businesses always drive the behavior that is expected in an organization. Successful businesses try to build high ethical culture from the top management level to the lowest and setting the standards for acceptable and unacceptable conduct in an organization.

It provides health-care professionals with ethical principles and standards by which to guide their practice. There are boundaries to the roles most of the codes can be used within. The expectation of what an ethical code can do changes depending on how ethical code in general is understood (Troy & Beringer, 2006).From my conclusion an ethical code can establish important values and describe a common ethical background for health care but is of limited use with solving new ethical problems.

As healthcare providers, maintaining a patient’s confidentiality, human dignity and privacy is expected at all times. Nurses are faced with maintaining patient confidentiality on a daily basis. The Coded of Ethics for Nurses is the framework of nonnegotiable ethical standards and obligations that all nurses are to uphold. Nurses are to be accountable for their actions and are expected to advocate and strive to protect the rights, health and safety of patients (American Nurses Association, 2011).

Ethical Codes are in use today by many organizations to clearly establish their values and provide a procedure if a code violation occurs. Medical ethics began as a professional code for physicians and has now expanded and includes a variety of health care professions and health care organizations. The growth of medical knowledge and technology have grown so have the concerns that ethical standards and issues facing our society today may be compromised or not appropriately addressed (Littleton et al., 2010).

A code of ethics is a set of written principles regarding conduct and behavior created by the organization to serve as a guide. The purpose of ethical codes is to give its employees, management, and any interested party a reference point that adheres to company policy, standards, and ethical beliefs. The code is made visible to the public to ensure professional integrity, quality, and to prevent misguided conduct. Regardless of the organization or governing body a code serves as a go-to guide because ethical issues can stem from anywhere at any given time. The Code of Ethics for Nurses is so dynamic because as technology changes, so does the code to ensure that updated knowledge is provided to healthcare workers as they address new ethical