HIM Ethical Challenges

Melinda Burns Smith, RN CPCWestern Governors University

Task Two June 2015

HIM Ethical Challenges

• This presentation will present some ethical challenges that HIM professionals may encounter in their professional, workday environments.

• We will be discussing the following objectives:• 1) Describe ethical challenges in HIIM• 2) Discuss those concerns• 3) Describe the AHIMA Code of Ethics• 4) Relate the sections of the code to the scenarios

Ethical Challenge: Fraud in Coding

• The coding supervisor, with RHIT & CCS credentials, works for a small, for-profit hospital and has let the coding staff know they must routinely assign higher E/M codes than the documentation indicates.

• Three coders, in particular, who also hold the CCS credential, are upset at the situation and are told that if they don’t come on-board with it, they should look elsewhere for jobs.

• The ethical concern is one of fraud being perpetrated by a person at the expense of correct coding and damage to the coders reputations, as well as AHIMA.

• Principle II, 2.1 and 2.4 are violated, it instructs members to conduct work in honorable ways.

• Principle IV, 4.1, calling for the refusal of staff to engage in unethical practices has been violated by the supervisor. AHIMA Code of Ethics. (2011)

Ethical Challenge: Staff Education

• A large hospital has employed a new health information management director who holds an RHIA and CPHQ. She goes to many meetings yearly but does not allow her staff of six, who are also credentialed, to go to any educational meetings. The volume of work is always cited as the reason she can’t let her staff go to educational offerings.

• The manager is not respecting the credentials of her staff and making it impossible for them to meet their CEU obligations.

• This can lead to disgruntled staff who may leave and take their valuable training with them.

• Principle V, 5.1, 5.3, and 5.7 are being violated here by the HIM director. It calls for the advance of health information knowledge and practice through continuing education. AHIMA Code of Ethics. (2011)

Ethical Challenge: Delinquent Records

• An HIM graduate of three years is newly employed at a mid-sized facility. He is asked to compile the chart delinquency rate and finds some incomplete charts in a pending file > 30 days old. He has to choose whether to include the older charts which would make the delinquency higher than the required standard by the Joint Commission or intentionally misrepresent the rate to make the facility comply.

• The ethical thing to do would be include the incomplete files in the final report.

• If the HIM professional is not a member of AHIMA, he may be unaware of the code of ethics. If a member, there may be harm to the organization with unethical practices.

• Principle IV comes into play here. It addresses the refusal to participate in or conceal unethical practices or procedures. AHIMA Code of Ethics. (2011)

Ethical Challenge: Unauthorized Record Access

• Alice is in the final semester of her HIM course at a local college. The only hospital in town has a HIPAA compliance specialist training program that Alice has applied for after graduation. She has started her Professional Practice Experience at the hospital and has become close with some of the staff. She overhears a staff rumor at lunch regarding the illness of the director of the Diagnostic Imaging Center, the department where her husband works.

After lunch, Alice returns to her station where she pulls up the medical record of the director, William and sees the prognosis for herself. At home, she convinces her husband Brad to approach the director with an offer to help. William complains to the HIM director, an audit report of logins is run, and Alice’s login is found. She is confronted and admits to the unauthorized viewing of the record.

Ethical Challenge: Unauthorized Record Access

• Principle I, 1.1 has been violated-uphold and defend the individual’s right to privacy and confidentiality.

• Principle II, 2.1 was violated-put the welfare of persons before self-interest.

• Principle III, 3.1 and 3.2 is probably the most severely violated-preserve, protect, and secure personal health information and hold in highest regard the contents of records. AHIMA Code of Ethics. (2011)

• Alice also violated HIPAA and ARRA regulations regarding William’s right to privacy by accessing his record.

• She was not a direct caregiver for the patient and had no business being in the medical record.

• At least she did not compound the problem by lying about the incident.

Discussion Questions

• The ethical challenge: Fraudulent Coding

• 1) What should the CCS certified staff members do with regards to the unethical request?

• 2) What would happen if they were to comply?

Discussion Questions

• Ethical challenge: Delinquent records• 1) Should the incomplete records be included

and did the HIM graduate act appropriately?

• Ethical challenge: Staff education• 1) Are the manager’s staff within their rights

to complain to HR about the situation?• 2) Should they try to talk to the manager?

Summary

• Members of AHIMA agree to uphold the Code of Ethics in daily practice and these obligations are at the heart of each member’s responsibility, regardless of where they may work or the collection, security and storage of health information

• “The code also prohibits HIM professionals from participating in or concealing unethical practices…the code serves as a guide by which individual actions can be judged.” Crawford, M. (2011) Everyday Ethics. Journal of AHIMA 82 (4)

References

AHIMA Code of Ethics. (2011, October 2). AHIMA HIM Body of Knowledge. Retrieved from http://library.ahima.org/xpedio/groups/public/documents

Crawford, M. ( 2011, April). Everyday Ethics. Journal of AHIMA. 82(4) 30-33

McWay, D. C. (2010) Legal and Ethical Aspects of Health Information

Management (3rd ed.) New York: Delmar