You are a health information manager in a financially troubled acute care hospital responsible for coding functions. The hospital’s administration has retained an independent consultant who has promised to increase the hospital’s financial reimbursement under Medicare. The consultant recommends that your staff be more aggressive in applying diagnostic codes in order to elevate reimbursement. Furthermore, the consultant shares with you the methods that can be used to avoid the detection of the aggressive coding scheme. You believe this more aggressive approach is, at minimum, inappropriate—and at worst, illegal. You have further learned that the consultant’s fee is based in large measure on a percentage of the hospital’s increased reimbursement under Medicare. Identify the ethical challenge and discuss how you would handle this situation. Submit 1,350 -1,500-word paper plus a title page and reference page in a scholarly format.
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Introduction:
As a health information manager, it is essential to uphold ethical values and principles that promote transparency, honesty, and accountability in the healthcare system. However, when faced with an ethical dilemma, it is necessary to carefully evaluate and weigh the options to ensure that the best course of action is taken. In this scenario, an independent consultant has proposed a strategy that involves aggressive coding of diagnostic codes to increase financial reimbursement under Medicare. This paper will identify the ethical challenge and discuss how to handle the situation.
Ethical Challenge:
The primary ethical challenge presented in this scenario is the conflict between the proposal made by the consultant to increase financial reimbursement under Medicare and the principles of honesty, transparency, and accountability in the healthcare system. While it is understandable that the hospital’s administration is striving to enhance its financial performance, aggressive coding schemes that may not reflect a patient’s actual condition can be viewed as deceptive and even fraudulent.
Furthermore, the consultant’s fee is based on a percentage of the hospital’s increased reimbursement under Medicare, which raises concerns about personal gain that may be detrimental to the hospital’s reputation and the healthcare system as a whole. Therefore, the health information manager faces a moral and ethical dilemma concerning which path to take that will uphold the principles and standards of the healthcare system.
Handling the Situation:
As a health information manager, it is crucial to approach this ethical challenge systematically and evaluate the optimal path to take, bearing in mind the potential implications of the decision. The following are some of the steps that can be taken to handle the situation effectively:
1. Review the hospital’s policies and guidelines: The health information manager should examine the hospital’s policies and guidelines regarding coding functions to understand procedures and the compliance process that must be followed. Policies and guidelines that promote ethical values and principles should be followed to ensure that the hospital’s reputation is preserved.
2. Research the recommendation made by the consultant: The health information manager should conduct in-depth research on the consultant’s proposed approach and determine its legality and validity. This helps to establish the risk and reward of adopting the recommended approach.
3. Consult with knowledgeable individuals: The health information manager should engage with knowledgeable individuals, including ethics consultants, attorneys, and healthcare management professionals, to gain perspective and advice on how to proceed.
4. Educate and inform the hospital administration: If the consultant’s proposal violates the hospital’s policies or ethical principles, the health information manager must educate and inform the administration about the risks of adopting such an approach, including potential legal ramifications.
5. Raise concerns with the consultant: The health information manager should raise ethical concerns with the consultant and question the validity of their proposal. If the consultant insists on adopting the aggressive coding scheme, the health information manager should refuse to participate, as this would violate the ethical principles and standards of the healthcare system.
Conclusion:
The ethical challenge presented in this scenario requires careful consideration and analysis to determine the best course of action. It is essential to maintain transparency, honesty, and accountability to ensure the integrity of the healthcare system is preserved. By following policies and guidelines, conducting research, seeking advice, educating the hospital administration, and raising concerns with the consultant, the health information manager will make ethical and morally sound decisions.
