WGU C801 Task 2 |Latest Update with Complete
Solution
A1. There are many Ethical issues that could take place in the HIM
department. Three of the more common ethical issues would be violating
patient privacy, misusing work resources outside the scope of your job
duties, and coding claims incorrectly when the documentation doesn’t
support the procedure or diagnosis billed for reimbursement purposes.
A1a. HIM professional are expected to stay within the scope of their
position when accessing PHI to perform their job duties. An ethical
challenge that is seen often is when a family member, or friend approaches
you after receiving a bill they do not feel they owe and are asking you to
investigate this for them. A HIM professional should only use company
issued equipment for the purpose of fulfilling their job duties. A work
computer should not be used for personal use, and websites with company
information should not be used on personal computers. An ethical challenge
in this situation would be using a company computer to view your Facebook
page, or using the provider portal with your login information from work on
your personal computer to view you or your family/friends claims. Last, a
HIM professional is expected to use coding for services that have been
rendered and are properly documented. An ethical issue in this situation
would be coding a claim with the highest level of care for an exam for a
higher reimbursement amount when the documentation justifies a lower
level of care, and lower reimbursement rate.
A1b. Having a family member or friend ask you to investigate their account
due to receiving a bill poses a concern in the HIM profession because they
are not following the proper protocol for requesting their account to be
reviewed. They are asking the HIM employee to go against hospital policy
and has only provided verbal authorization to investigate the account. Using
facility issued equipment for personal use such as scrolling on Facebook can
put the work computer at risk of a data breach exposing PHI and
confidential facility information to be accessed. Coding a claim for higher
level of care to have a higher reimbursement rate is a pose for concern
because this would be fraudulent billing.
A1c.
Solution
A1. There are many Ethical issues that could take place in the HIM
department. Three of the more common ethical issues would be violating
patient privacy, misusing work resources outside the scope of your job
duties, and coding claims incorrectly when the documentation doesn’t
support the procedure or diagnosis billed for reimbursement purposes.
A1a. HIM professional are expected to stay within the scope of their
position when accessing PHI to perform their job duties. An ethical
challenge that is seen often is when a family member, or friend approaches
you after receiving a bill they do not feel they owe and are asking you to
investigate this for them. A HIM professional should only use company
issued equipment for the purpose of fulfilling their job duties. A work
computer should not be used for personal use, and websites with company
information should not be used on personal computers. An ethical challenge
in this situation would be using a company computer to view your Facebook
page, or using the provider portal with your login information from work on
your personal computer to view you or your family/friends claims. Last, a
HIM professional is expected to use coding for services that have been
rendered and are properly documented. An ethical issue in this situation
would be coding a claim with the highest level of care for an exam for a
higher reimbursement amount when the documentation justifies a lower
level of care, and lower reimbursement rate.
A1b. Having a family member or friend ask you to investigate their account
due to receiving a bill poses a concern in the HIM profession because they
are not following the proper protocol for requesting their account to be
reviewed. They are asking the HIM employee to go against hospital policy
and has only provided verbal authorization to investigate the account. Using
facility issued equipment for personal use such as scrolling on Facebook can
put the work computer at risk of a data breach exposing PHI and
confidential facility information to be accessed. Coding a claim for higher
level of care to have a higher reimbursement rate is a pose for concern
because this would be fraudulent billing.
A1c.
