Medical coding is an essential part of medical practices because it helps the practice to receive reimbursement from insurance companies for services provided. While the focus on maximizing repayments may be understandable, up-coding or falsifying documentation can result in unethical and illegal behavior that has serious consequences for both patients and the medical practice.
Up-Coding and Falsifying Documentation
Up-coding encompasses billing for services with codes that reflect a higher level than what was actually performed (e.g., billing for an office visit when testing was only done) or misrepresentation of medical procedures with high cost diagnostic codes (e,.g., replacing one code with another). In addition, falsification entails documenting information incorrectly in order to support another coding decision such as adding symptoms not truly present during examination.(Sharifi , 2020). These activities are considered fraudulant since they manipulate Medicare/Medicaid by drawing payments without providing accurate representations of billed serveices which could jeopardize patient safety ad experience while significantly increasing healthcare costs(Payne et al.,2020).
Conclusion
The pressure of achieving maximum reimbursements must never override professional ethic considerations regarding patient care as well as legal requirements concerning truthful reporting. Ultimately up-coding policies must be established and implemented by administrators to ensure accuracy, consistency and integrity throughout their organization.
References
Payne JE, Smith ML ,Stroobandt S,Lucas P .(2020) Upcoding: A Professional Reputation Risk Worth Managing? Med Care Res Rev .77(2):180–195. doi: 10.1177/1077558719858647 Sharifi M.(2020) Common Fraudulent Practices Associated With Electronic Health Records & Insurance Billing | Chron Retrieved March 2 2021from https://smallbusinesschron/commonfraudulentpracticesassociatedelectronichealthrecordsinsurancebilling170327html
Scenario 2: Administration of Patient Medications in the Hospital Setting
Medication errors occur frequently within clinical environments due to human error or miscommunication during drug administration processes; however some clinicians often omit disclosing these incidents due to fear of negative repercussions associated with admitting fault through immediate reporting thereby creating greater potential harm towards patents if not corrected swiftly appropriately under safe environment Moreover even small miscalculations incorrect dosages infuse wrong medication type particular situation greatly increases risks involved Ironically despite failure report incident practitioner still responsible liabilities arise out omission hence individual engaged find himself herself compromising own profession directly indirectly
Rationalization behind opting disclose provide interesting insight internal thought process usually abide Nevertheless aside ethical implications there procedural expectations hospital settings reliable solid system put place basis effective communication hierarchy exists between lower ranking staff members heads departments Institutions mandated report certain incidents certain corporations such Joint Commission American Board Medicine Initiatives exist foster safety culture concentrated Healthcare Standards preventative measures operation plan enacted guarantee documents record kept maintained avoidance future recurrences minimized possibly avoided altogether Additionally outside agencies allowed conduct random auditing competency checks verify adherence policy regulations reduce inconsistencies event someone hold liable charges brought forth before standard procedure followed core issue addressed head
Legality covers wide area depending upon country jurisdiction laws implementing rules changes drastically different countries while US based discuss matter subject slightly leniently topic viewed more seriously Europe Pacific Rim regions reason stay ahead game think ahead any could prove detrimental affair organziation institution most importantly affect credibility individual held responsible easily tarnished Consider impact potential violation committed especially those involving drugs narcotics Reporting difficult situations circumstances would merit praise rather questioned motivate right action betterment all parties concerned protect everyone possible damages matters worth addressing doing immediately resolving quickly safely efficiently
Conclusion
Clinicians should always adhere strict guidelines when administering medications so mistakes can be avoided at all times but errors do happen unfortunately which is why disclosure is key—reporting any incidences will form parts preventive measure thereby allowing investigative work begin avoid similar occurrences taking place moving forward Taking responsibility dealing truth prevents larger problems arising later allows proper channels resolve professionally thoroughly Additionally creates awareness colleagues surrounding environment raises questions begins dialogue further discussion overview Overall promotes safe environment free fraudulent practices hazards legitimate important note uphold trust needed build confidence amongst patients staff alike ultimately leads healthier healthier outcomes enhanced quality life entities endured bad experiences
References National Council State Boards Nursing Inc (NCSBN), The Truth About Nurse Retention wwwncsbnorg 2014 Accessed March 4 2021 retrieved fromhttpswwwjointcommissionorgstandards_informationstandardsshowstandardaspxissueidPC_07 Payne JE Smith ML Stroobandt S Lucas P Upcoding A Professional Reputation Risk Worth Managing? Med Care Res Rev 77 (2):180–195doi1011771077558719858647820 Rodriguez D Errors What You Can Do To Reduce Them Patients Safety Authority Pennsylvania Summit News 2012 Accessed March 4 2021 retrieved fromhttpspatientsafetyauthorityorghomepsawhatyoudocloserrrorshtm Uribe Ramirez N Morales Fuenzalida L Campos Saez ÁL Hijano Medina R Lavandera García E Pharmacists’ Role In Documents Of Suspicious Drug Prescriptions International Journal Research Technology Management IJRTM Volume 39 Issue 5 2018 pp 3541 Accessed January 8th 2021 available httpwwwscopemedorgpdfsIJRTM6Vol39Issue5FTPABPDF Yost M Altering Records And Facts In Records New York State Department Health 2010 Accessed March 4 2021 retrieved fromhttpwwwnysdohgovpfpsporganizationalintegrityelteringrecordsasp.
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