Health Information Management Case Study

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.

1). What is the ethical question?

The ethical question is whether it is ethical to upcode medical charts in order to maximize revenue for the multi-specialty clinic.

2a). What are the known facts?

The venue is a multi-specialty clinic with high patient volume.

The physicians enter classification codes that will yield the highest revenue for the clinic.

I suspect that the codes that the physicians are submitting for payment are not accurate. Entering inaccurate codes that will yield the highest revenue for the clinic is called “upcoding”.

The patient, in order to have confidence in the health care provider demands that medical chart is accurate

Health Information Management (HIM) professional: Will expect that the healthcare providers are honest, accurate in their diagnoses, and the charges are legal, fair, and correspond to services rendered on the given day. All inaccuracies must be corrected as soon as discovered to inspire confidence in the HIM professional, the facility, and all the organization’s employees. All stakeholders depend upon the HIM professional to maintain the accuracy, privacy and security of the patient’s medical charts, and thereby secure the reputation of the facility and welfare of the patients.

Healthcare professionals: Seek the beneficence and nonmaleficence of the patient by giving them truthful and accurate documented services and charging fair legal rates according to standard industry protocols that are reproducible, verifiable, and truthful for the services

Health IT provides the protection of patients’ privacy, confidentiality, and allocating resources in a fair way across programs, services, and patients. Health IT makes available information from the health record and from many authoritative sources that informs patients and clinicians to a point that they are collaborators in the quest to improve the health of the patient longitudinally. That is, from cradle to grave. Ethical practices in end of life care or palliative care is another area where health IT can provide information to clinicians and patience to address patient issues near the end of life. This would include the options of choosing facilities for independent living, or assisted living and/or nursing care facilities. Health IT can assist patients to reenter the work force and support a valuable aspect of providing a living for those disabled or with diseases that may have reduced or eliminated their ability to secure gainful employment. Health IT is effective in teaching clinicians about how to behave with certain patient populations (Fox, Crigger, Bottrell, & Bauck, n.d., p.