In this day of cyberattacks and stolen identities, it is imperative to guard personal information. For medical billers and coders, it goes a step beyond: They also must follow a strong standard of ethics while protecting patient and client information.
It’s not always that easy, and sometimes the lines are blurred. Regulations regarding licensing and certification in the healthcare industry require that everyone employed in the field has the proper training and qualifications. In addition, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 was passed to ensure the privacy and security of patients’ healthcare information. However, healthcare professionals are tasked with enforcing HIPAA – and sometimes, through human error or breaches, information gets out or is misused. It’s the misuse that must be looked at from an ethical standpoint.
Medical billers and coders keep doctors and nurses on track and organized, and record in clear terms a patient’s medical history. One slip-up with an improper code could mean big trouble for a patient. It could result in the wrong treatment (imagine mistakenly coding a lymphoma, cancer, for a lipoma, a benign fatty tumor). Occasionally, billers and coders are asked to make intentional slip-ups to optimize revenue for the medical facility at the expense of actual documentation. They may be under pressure to “upcode” or “unbundle” procedures to extract more reimbursement from patients or insurance companies. This is just one glaring example of unethical behavior that can present itself in healthcare.
The American Medical Association (AMA) published Principles of Medical Ethics as a general guideline for healthcare professionals to follow. If medical billers and coders are faced with potentially unethical situations, they can refer to the AMA’s guide, and they can keep these things in mind:
- Maintain confidentiality. Don’t access unnecessary patient information or share it with anyone other than the physician, patient or insurance company. Password-protect your computer at work, and keep the screen faced away from others who could peek at the information. Also, keep your conversations about patients as quiet as possible so that those who shouldn’t hear, can’t hear.
- Avoid conflicts of interest. Even if a good friend or relative is being treated at your facility, you need to stay neutral and not give them preferential treatment. You should remain neutral when performing your duties.
- Be honest above all. Don’t code for procedures that were not provided or unbundle charges so as to get more compensation for the company. If you’re being pressured to do something that you know is not right, say something to your employer; don’t shrug it off. If you notice anything questionable, bring it up. For example, some people who are addicted to certain prescription medicines will go from doctor to doctor to obtain an Rx. If you think you’ve encountered such a patient, bring it up to the doctor.
- Keep patients’ rights at the forefront. Patients have a right to be treated with dignity, and you have an obligation to be kind and diplomatic. If you have to phone a patient with information, choose your words carefully – especially if you must leave a voicemail that could be heard by someone else.
- Stand your ground and maintain your personal integrity. Be calm and collected, and do what you know is right. Don’t be pressured into doing something that you know violates the law or is unethical.
- Pay attention to detail. When you’re coding, make sure that your work is accurate. Keep up with the latest information on billing and coding issues. Since your job is to abstract billable procedures from medical records, they must all be documented. If it’s just briefly mentioned and not noted by the doctor as having been done, find out for sure. In other words, resist the temptation to submit codes that are only implied and not documented. Also, watch for discrepancies in medical records.
- Be mindful of your behavior. If you’re a freelance biller or coder working for multiple facilities, keep each one’s policies and practices confidential.
- Use your manager as a resource. If you’re not sure about a code, or if you think a colleague has intentionally misused a code, talk to your boss. Never condone or pardon those who intentionally commit deceptive acts.
- Don’t exploit relationships with patients, clients, employees or coworkers for personal gain.
Medical coding and billing are the heart of healthcare industry. As the U.S. population rapidly ages, people usually require more medical care. Medical coders and billers are needed to handle insurance and patient claims. MTI College offers a Medical Billing and Coding Professional Diploma Program that can prepare you to enter this in-demand field. You could be working alongside doctors and nurses in a hospital, doctor’s office, clinic, nursing home or other medical facility, using your skills to provide much-needed assistance.
According to the Bureau of Labor Statistics, the employment rate for medical records and health information technicians (billers and coders) is growing much faster than the average for other occupations. Because more people have access to health insurance these days, claims on behalf of patients are going to increase. If you have a medical billing job, you will be the one to submit the bills for insurance reimbursement.
Does this sound like a job you would enjoy? Contact MTI College Sacramento today to jump-start your medical billing or coding career.