Medical Coding Ethics

Agenda

AHIMA's Standards of Ethical Coding

• Description of Standards
• Who This Applies To
• Why Have These Standards?

Standards Defined With Scenarios

• Standard 1: Apply Accurate, Complete, and Consistent Coding Practices That Yield Quality Data
• Standard 2: Gather and Report All Data Required for Internal and External Reporting, in Accordance With Applicable Requirements and Data Set Definitions
• Standard 3: Assign and Report, in Any Format, Only the Codes and Data That Are Clearly and Consistently Supported by Health Record Documentation in Accordance With Applicable Code Set and Abstraction Conventions, and Requirements
• Standard 4: Query and/or Consult as Needed With the Provider for Clarification and Additional Documentation Prior to Final Code Assignment in Accordance With Acceptable Health Care Industry Practices
• Standard 5: Refuse to Participate in, Support, or Change Reported Data and/or Narrative Titles, Billing Data, Clinical Documentation Practices, or Any Coding Related Activities Intended to Skew or Misrepresent Data and Their Meaning That Do Not Comply With Requirements
• Standard 6: Facilitate, Advocate, and Collaborate With Health Care Professionals in the Pursuit of Accurate, Complete and Reliable Coded Data and in Situations That Support Ethical Coding Practices
• Standard 7: Advance Coding Knowledge and Practice Through Continuing Education, Including but Not Limited to Meeting Continuing Education Requirements
• Standard 8: Maintain the Confidentiality of Protected Health Information in Accordance With the Code of Ethics
• Standard 9: Refuse to Participate in the Development of Coding and Coding Related Technology That Is Not Designed in Accordance With Requirements
• Standard 10: Demonstrate Behavior That Reflects Integrity, Shows a Commitment to Ethical and Legal Coding Practices, and Fosters Trust in Professional Activities
• Standard 11: Refuse to Participate in and/or Conceal Unethical Coding, Data Abstraction, Query Practices, or Any Inappropriate Activities Related to Coding and Address Any Perceived Unethical Coding Related Practices

Standards Summary

• Recognizing Ethical Situations
• Reporting Ethical Situations

Credits

Faculty

Rachel Mitchell, CIC, COC, CPC, CRCR

Xtend Healthcare

• Associate Vice President of Mid Revenue Cycle at Xtend Healthcare
• With more than 20 years of health care coding and auditing experience, she holds several certifications, including CIC (Certified Inpatient Coder), COC (Certified Outpatient Coder) and CPC (Certified Professional Coder) through AAPC, CRCR (Certified Revenue Cycle Representative) through HFMA, and is also an AHIMA Approved ICD-10 CM and PCS trainer
• She brings extensive knowledge of revenue cycle process improvements in several areas including: patient access, patient financial services – billing, denials and appeals, coding and HIM management, charge capture and chargemaster reconciliation
• Manages coding operations, denials & appeals management services, and RCO clients for Xtend Healthcare; she is currently mentoring staff to receive additional coding credentials with AHIMA
• Speaker at the 2019 National AHIMA Convention
• AAPC, AHIMA, HFMA
• Associate of Arts; current student at University of Illinois at Chicago (UIC) enrolled in the Health Information Management bachelor’s degree program
• Can be contacted at [email protected]