INTRODUCTION OF CODING Coding is the allocation of alphanumerical values onto a word, phrase, or other nonnumerical expression (Davis, 2014). A coder is a professional that applies these elements into a system for delivery. Each code is unique in that it pertains to a medical diagnosis or procedure. These codes are delivered in a form of a bill to companies for payment of services. The professional standards by which coders must abide by are set forth by the American Healthcare Information Management Association (hereinafter “AHIMA”). As each profession has a code of ethics so do a set of standards that they are required to operate under. These are imposed by a credentialing entity that further provides a license to operate in such a setting. …show more content…
The utmost emphasis should be placed on coding as it is main source of income within any healthcare facility. STANDARDS OF ETHICAL CODING/ POLICIES AND PROCEDURES Our procedure manual will include the principles that AHIMA outlines such as: 1. Applying correct and consistent coding practices with quality data; 2. Gather and report all data required for internalization reporting as well and external, in accordance with the requirements and data definitions; 3. Only gather and report the codes and data that are further supported by health record documentation in accordance with the code and requirements; 4. Confer with the provider, if needed on clarification and additional documentation prior to the finalizing the code in accordance with the healthcare practices in place; 5. Refuse to partake in, change, or supported data, billing, documentation practices, or any activity relating to the code that is a false representation of such data that does not correspond with the requirements; 6. Collaborate with other healthcare professionals on the accuracy, completeness, and reliability of the code, especially in scenarios that support ethical coding …show more content…
Should codes not be correctly billed, a delay in payment or denial of payment for services rendered can result. This puts the organization in a situation wherein they are unable to sustain sufficient revenue to operated. Thus, professional coders hired externally mistake and/or erroneous coding should signal the organization to contract more competent professionals. This occurs in an effort to allocate more of the organization’s expenses towards higher salaries for their staff members, updated facilities, etc. What most facilities eventually take notice is that outsourcing such a paramount task will cost them more in the long run. CONCLUSION AHIMA is widely renowned for their core business practice. They provided all healthcare organizations a standard platform for the compliance of their coding practices. Supervisors pay close emphasis on the provisions and that their organization is following these standards of ethical coding. They provide regulatory requirements proven to maintain order and success in the industry. Their requirements are in accordance with the Affordable Care Act (hereinafter referred to as “ACA”). ACA provides strict regulation with the compliance of their legal and
Medical billers often communicate with physicians and other health care professionals to explain diagnoses or to attain further information by means of phones, email, fax, etc. The biller must know how to read a medical record and be familiar with CPT®, HCPCS Level II and ICD-9-CM codes.
NAEYC. (2005, April). Code of Ethical Conduct and Statement of Commitment. Retrieved May 13, 2010, from NAEYC.org: http://www.naeyc.org/files/naeyc/file/positions/PSETH05.pdf
Langenbrunner, J., Cashin, C. & Dougherty, S. (2009). Designing and implementing health care provider payment systems how-to manuals. Washington, D.C: World Bank.
Health Information Technology for Economic and Clinical Health Act consists of several subtitles. The subtitle D of the Health Information Technology for Economic and Clinical Health Act deals with the privacy and security issues that are associated with the electronic transmission of health information. The Health Information Technology for Economic and Clinical Health Act requires that as of 2011 all healthcare providers are going to be presented with the opportunity of financial incentives for showing meaningful use of electronic health records (EHRs). The proposed incentives will be offered up until 2015 and after that, penalties may occur for the failure of representing the use of EHR. The Health Information Technology for Economic and Clinical Health Act even started grants for the training centers for all staff members that are required to support a health information technology infrastructure. (www.healthcareitnews.com).
Department of Health and Human Services (DHHS) to safeguard patient privacy. It protects patients’ health information (PHI) and allows patients to have control over the distribution of their information. Due to the advancement in technology and shift from paper to electronic files, the development of both state and federal laws occurred to protect the electronic health care transactions, code sets, unique health identifiers and security (DHHS, 2016). In addition, due to e-PHI a Privacy Rule was published in December 2000, to protect health information under these entities: health plans, healthcare clearinghouses, and health care providers who conduct certain health care transactions electronically. This law implements various types of health facilities; including, hospitals, doctor offices, pharmacies, health plans, and other clinical care sites (Field, p. 199).
One of the demands in healthcare today is to have the ability to allow healthcare organizations to exchange patient health related information with other healthcare organizations. This was made possible by the creation of the electronic health record (EHR), electronic medical record (EMR) and personal health record (PHR). The EHR, PHR and the EMR allowed for patient’s paper medical charts into transformed into electronic charts. This allowed for a better way to organize the information that was contained the paper medical chart. The health organization began to realize they could use these electronic charts for a better way to care and share patient health related information. However, as the transmission of data continued, the need for standards developed to insure the interoperability of these healthcare systems. Two of the standards that were created in order to help with the electronic transmission of medical data are the Continuity of Care Record (CCR) and the Continuity of Care Document (CCD).
Which of the six principles in the AICPA Code of Conduct is most related to Article 1.5 of the California Accountancy Act? Explain your conclusion.
Maintaining an open mind and learning what one can in terms of national and facility-specific standards will help equip one to perform his or her duties as expected. Above all, the overall care of the patient – mental, physical, financial and spiritual - is paramount.
Many GPs produce practice charters that offer information about that standard of service delivered by their particular health centres. Information which most probably be covered is time schedule, collection of test results, how to get proscribed medication, facilities available to disabled people and further treatment.
Tan & Payton (2010) describe the electronic health record (EHR), which dates back to the 1950s. These computer-based patient records have evolved into complex systems with many capabilities. They were designed to provide healthcare professionals with a comprehensive picture of a patient’s health status at any time and are meant to automate and streamline the workflow of the healthcare professional (Tan & Payton,
The health care provider should ensure that they communicate effectively with the patient/client.
Case 1 -- You work in a busy multi-specialty clinic with a high patient volume. The physicians enter the type of code that will yield the greatest reimbursement. You suspect the codes are not accurate.
The EHR is defined as “an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization” (Fahrenholz, C. G. & Russo, R., 2013b). The Office of the National Coordinator for Health Information Technology (ONC) has published a list of required items an EHR must have to satisfy the complete EHR definition. According to the ONC, the EHR must include, for both ambulatory and inpatient systems: computerized provider order entry, demographics, a problem list, a medication list, a medication allergy list, clinical decision support, transitions of care, data portability, clinical quality measures, authentication, access control and authorization, auditable events and tamper resistance, audit reports, amendments, automatic log-off, emergency access, end-user encryption, integrity, drug-drug and drug-allergy interaction checks, vital signs, body mass index and growth charts, electronic notes, drug-formulary checks, smoking status, image results, family health history, patient list creation, patient-specific education resources, electronic prescribing, clinical information reconciliation, incorporation of lab tests and values/results, immunization information, transmission to immunization registries, transmission to public health agencies-syndromic surveillance, automated measure calculation, a safety-enhanced design, a quality management system and be able to view, download and tra...
Step three involves developing a care plan that will include all cultural factors involving the patient’s care. Step four is implementation of the care plan by the healthcare team and those involved with the patient’s care. Step five is the last step and evaluates the care plan to make sure that the quality of care is acceptable and is based on scientific evidence and best practices. If there are any changes or adjustments that need to be made to the patient’s care, modifications will be made to the care plan and these steps should be repeated (Andrews & Boyle, 2016).
Many companies have a code of ethics or better known as a policy statement. A code is a form