Accessed February 5, 2016. Dummies has always stood for taking on complex concepts and making them easy to understand. By implementing auto-adjudication within the claims processing workflow, payers, providers, and members can see an influx of faster and more accurately processed claims. How do you stay ethical when working in medical billing and coding? 0 How important are ethics with claims processing? {"appState":{"pageLoadApiCallsStatus":true},"articleState":{"article":{"headers":{"creationTime":"2016-03-26T17:13:10+00:00","modifiedTime":"2016-03-26T17:13:10+00:00","timestamp":"2022-09-14T18:06:45+00:00"},"data":{"breadcrumbs":[{"name":"Body, Mind, & Spirit","_links":{"self":"https://dummies-api.dummies.com/v2/categories/34038"},"slug":"body-mind-spirit","categoryId":34038},{"name":"Medical","_links":{"self":"https://dummies-api.dummies.com/v2/categories/34077"},"slug":"medical","categoryId":34077},{"name":"Billing & Coding","_links":{"self":"https://dummies-api.dummies.com/v2/categories/34079"},"slug":"billing-coding","categoryId":34079}],"title":"Ethics Are Critical to the Billing and Coding Profession","strippedTitle":"ethics are critical to the billing and coding profession","slug":"ethics-are-critical-to-the-billing-and-coding-profession","canonicalUrl":"","seo":{"metaDescription":"As a medical biller or coder, you must consistently do the right thing at work, especially related to providers, payers, and patients. In fact, HIPAA allows for such disclosures for the purposes of payment without authorization, and it also allows broadly for disclosures with authorization, which patients are usually required to grant to their insurers as a condition of coverage and to their providers to facilitate submission of claims. There are generally 12 business ethics principles: Leadership: The conscious effort to adopt, integrate, and emulate the other 11 principles to guide decisions and behavior in all aspects of. If you violate them, legal action can take place in the form of sanctions and fines. Examples in state law include general medical confidentiality laws, those implementing the HIPAA privacy rule, and minor consent laws, along with many others [2]. To address this, states are beginning to adopt a variety of statutory and regulatory approaches to protect patients privacy, even as a wide array of communications continue to occur among health care providers, insurers, policyholders, and patients in billing and health insurance claims processes. Family Violence Prevention Fund. Take stealing, for example: Case 1: a person with no money steals cigarettes from a tobacconist because they are addicted to smoking. To avoid the negative implications, companies are devoting more resources to business ethics. Related: the most important medical billing laws. Abigail English, JD is the director and founder of the Center for Adolescent Health and the Law in Chapel Hill, North Carolina. A small slip of the tongue can get you into trouble, and cause serious problems for the patients. Code honestly, code accurately, and youll do just fine. 21 0 obj <> endobj Expedited Partner Therapy: Clinical Considerations and Public Health Explorations, Commentary 1, Barry DeCoster, PhD and Lisa Campo-Engelstein, PhD, One Model of Collaborative Learning for Medical and Law Students at the University of Baltimore and Johns Hopkins University, Gregory Dolin, MD, JD and Natalie Ram, JD, Expedited Partner Therapy: Clinical Considerations and Public Health Explorations, Commentary 2, Enabling Individualized Criminal Sentencing While Reducing Subjectivity: A Tablet-Based Assessment of Recidivism Risk, Pablo A. Ormachea, JD, Sasha Davenport, Gabe Haarsma, PhD, Anna Jarman, Howard Henderson, PhD, and David M. Eagleman, PhD, Conflicts of interest/Clinician relations with industry, http://www.cahl.org/policy-compendium-2nd-2005/, http://www.confidentialandcovered.com/file/ConfidentialandCovered_WhitePaper.pdf, http://www.guttmacher.org/pubs/confidentiality-review.pdf, http://www.futureswithoutviolence.org/userfiles/file/Health care/consensus.pdf, http://nahic.ucsf.edu/download/access-to-health-care-for-young-adults-the-affordable-care-act-of-2010-is-making-a-difference/, http://www.confidentialandcovered.com/file/ConfidentialandCovered_ResearchReport.pdf, https://olis.leg.state.or.us/liz/2015R1/Downloads/MeasureDocument/HB2758, https://malegislature.gov/Bills/BillHtml/141584?generalCourtId=12, http://codes.findlaw.com/ny/insurance-law/isc-sect-3234-nr3.html, https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=5853&fileName=3%20CCR%20702-4. What are the magnitude of the consequences and the probability that the consequences will happen. Unfortunately, you may encounter a manager who is less aware of correct coding rules or who, if cognizant of the rules, tends to bend or overlook them.
\nThese coding managers may see modifiers as a tool to increase reimbursement rather than a tool to increase specificity when reporting services, for example, and may challenge the coding of claims when reimbursement is low.
\nIf your manager or other superior encourages you to code out of bounds, dont. Know the laws concerning HIPAA. If the documentation is ambiguous, take the time to clarify what occurred with the physician.
\nAs the coder, you have access to both the patients clinical information and his or her personal demographic information, such as Social Security number, date of birth, address, and so on. Confidentiality of Health Information Act, S 138 sec 2(e), Reg Sess (Ca 2013). Code honestly, code accurately, and youll do just fine.
\nYou have nothing to gain by shifting the blame of inaccurate coding on to others. c The reality is, as margins shrink, it is more difficult for health systems to absorb the cost of denials simply as a cost of doing business. Accessed December 20, 2015. These are some of the most egregious of the ethical and legal violations that can land you in hot water if you ever stray from the straight and narrow. If you work in an environment with a department for each step of the coding cycle, ask for clarification as to how much leeway you have to facilitate. Another research indicates that 22% of customers demand direct communication with experts. ","hasArticle":false,"_links":{"self":"https://dummies-api.dummies.com/v2/authors/9225"}}],"_links":{"self":"https://dummies-api.dummies.com/v2/books/282386"}},"collections":[],"articleAds":{"footerAd":"
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