ETHICS ISSUE 4: Ethical Practices in Business and Management—Business Integrity 2. Ethical 3. Ethical Standard 4. Best Ethics 5. Metric 5. Current 1. Ethics Issue Standard Description(s) with Practice Ethics Practice Source(s) Exclusions “Should” “Is” Coding staff are not American Health Health information Coding staff should Numerator: 12 ÷ 100 = 12% routinely consulting Information management professionals ensure accurate Number of records with physicians to clarify Management shall not participate in, coding by reviewing ambiguous or conflicting Currently, conflicting or Association condone, or be associated conflicting or documentation where physicians are not ambiguous Code of Ethics with dishonesty, fraud and ambiguous physicians were not being contacted documentation in the abuse, or deception documentation with contacted for 12% of the electronic including: the physician of patient’s VHA Handbook records with _________________ health record, and Assigning codes without record. ambiguous or 1907.03 Health therefore enter physician documentation Denominator: Information conflicting inaccurate Coding when Number of records with Management documentation. information. documentation does not ambiguous or conflicting Clinical Coding justify the procedures that documentation Program have been billed Procedures Method: Record review Coding an inappropriate level of service Sample size: 100 Miscoding to avoid Time frame for data conflict with others collection: 1 week VHA policy states that when there is conflicting or ambiguous documentation in the record, the patient’s physician(s) must patient’s be consulted for clarification. Exclusion(s):
ETHICS ISSUE 4: Ethical Practices in Business and Management—Business Integrity 1. Ethics Issue 2. Ethical Standard Source(s) 3. Ethical Standard Description(s) with Exclusions 4. Best Ethics Practice “Should” 5. Metric 5. Current Ethics Practice “Is” Coding staff are not routinely consulting physicians to clarify conflicting or ambiguous documentation in the patient’s electronic health record, and therefore enter inaccurate information. American Health Information Management Association Code of Ethics VHA Handbook 1907.03 Health Information Management Clinical Coding Program Procedures Health information management professionals shall not participate in, condone, or be associated with dishonesty, fraud and abuse, or deception including: Assigning codes without physician documentation Coding when documentation does not justify the procedures that have been billed Coding an inappropriate level of service Miscoding to avoid conflict with others VHA policy states that when there is conflicting or ambiguous documentation in the patient’s record, the patient’s physician(s) must be consulted for clarification. Exclusion(s): Coding staff should ensure accurate coding by reviewing conflicting or ambiguous documentation with the physician of record. Numerator: Number of records with ambiguous or conflicting documentation where physicians were not contacted _________________ Denominator: Number of records with ambiguous or conflicting documentation Method: Record review Sample size: 100 Time frame for data collection: 1 week 12 ÷ 100 = 12% Currently, physicians are not being contacted for 12% of the records with ambiguous or conflicting documentation.
pe_btb_mod4_handouts_final_06162014.docx