HIMS 655 AHIMA Code of Ethics Discussion

The AHIMA code of ethics not only provides guidelines on how to be an efficient health information management (HIM) professional, but it provides insight on being an overall good person. It also offers insight on how healthcare organizations can create a culture for HIM that fosters value-based care. For the most part key factors speak to honesty, advocacy, security, transparency, and many other noble acts that protect the rights of all healthcare recipients. That’s basically everyone.

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In my current position I investigate Medicare fraud with regulatory guidance from the False Claims Act (FCA). Based on recent research the FCA protects the Medicare trust fund from being over-billed for healthcare products and services. Whether the act of fraud is done knowingly or not, violating providers can be penalized with substantial fines and/or criminal charges (oig.hhs.gov, 2021). The fee-for-service reimbursement model is prone to fraud, waste, and abuse because providers bill for every product or service prescribed in a patient’s treatment plan. Instances of overutilization and medically unnecessary treatment lend to billions of dollars in fraudulent claims. Certainly, the clinical codes that drive reimbursement put added importance and attention on having a coding compliance and ethics program in place (Bryant, 2018).

Based on recent research the principle of the AHIMA code of ethics that closely relates to my current work responsibilities is “refuse to participate in or conceal unethical practices or procedures and report such practices. Specifically, to not participate in, condone, or be associated with dishonesty, fraud and abuse, or deception like the following examples

Allowing patterns of optimizing or minimizing documentation and/or coding to impact payment
Assigning codes without provider documentation
Coding when documentation does not justify the diagnoses or procedures that have been billed
Miscoding to avoid conflict with others
Engaging in negligent coding practices (library.ahima.org, 2019)
HIM professionals must be mindful of policies and procedures in place that protect recipients’ access to healthcare. Acts of fraud, waste, and abuse rob taxpayers of their hard-earned dollars. It also limits the number of providers available to treat patients and limits resources necessary to offer value-based care. My key takeaway from the AHIMA code of ethics is to treat others the way that you would want to be treated. That is truly the most ethical act that anyone could perform.

References:

American Health Information Management Association. (2019, April 29). AHIMA Code of Ethics. AHIMA Code of Ethics / AHIMA . Retrieved February 11, 2022, from https://library.ahima.org/doc?oid=105098#.YgbHed_MJD9

Bryant, G. (2018, May). Coding compliance and ethics: Make it work and be

Peer 2:A Code of Ethics is a professional statement that serves as a guide for the conduct of professional activities and decision-making. The AHIMA Code of Ethics, first and foremost, holds the confidentiality and privacy of health information paramount addressing it in the preamble as well as throughout the rest of the code (AHIMA, 2019). Other points seem to be aligned with the information technology aspect of the profession as they are geared toward the responsible and appropriate use of data, information, and information systems. The final points approach how to be a better professional in terms of representing the profession in a positive light, bolstering the profession by teaching and recruiting, and facilitating collaboration through the interdisciplinary nature of health information.

Of course, working in healthcare, one of the most pertinent items is the protection of confidential health information. Those working in the healthcare profession have a sacred trust to protect the information of patients. Even through data exchanges and collection for research, HIM professionals are charged with the protection of privacy, maintaining confidentiality, and ensuring data remains secure throughout the spectrum of health information systems (Oachs & Watters, 2020). The code also invites the responsible use of information technology systems, and as widespread as electronic technologies are in healthcare now, this also applies to nearly everyone working in healthcare in some capacity. Overall, the code uses general ethical principles present in healthcare and applies them specifically to the management of health information.

Resources

American Health Information Management Association (AHIMA). (2019). AHIMA Code of Ethics. https://library.ahima.org/doc?oid=105098#.YgautN_MIUF

Oachs, P. and Watters, A. (2020). Chapter 27, Ethical issues in health information management. Health Information Management Concepts, Principles, and Practice (6th Edition).