Community standards of care and quality. Organizational viability and community reputation. Quo. 2. What legal issues need to be considered regarding this case? The legal issues relate to the organization’s protection’s and adherence to same for patient privacy and confidentiality especially concerning HAP.
At the moment from the vignette, there does not appear there has been a breach but Brenda has made a direct request for additional protections of her information. Additionally, depending how this is ultimately handled, the organization may have potential noncompliance concerns related to coding, billing and care delivery accuracy and timeliness.While there is mention of annual confidentiality statements by the HIM staff this does not appear to be comprehensive and competency based; therefore, experience and organizational formal policies and procedures related to compliance and other standards or lack there of can contribute to potential HAP and SMS violations. In addition, possible litigation and GIG sanctions could be outcomes if there is evidence of organizational noncompliance. Hypothetically since the vignette does not detail this has yet happened, any valid via HAP or other state / regulatory governance guidelines which constitute breaches of patient privacy confidentiality could potentially result in accountable employee termination, organizational liability including sanction and fines and reputation impacts.If Shirley, does not handle this all per organizational policy and procedure as well as industry/regulatory principles and guidelines, then she may expose the organization to discriminatory considerations from Brenda and/or the other employees. Additionally, professional conduct required by a position or lack thereof exposes risk related to appropriate work environment and as relates to billing protocols and potential fraud.
Without addressing these integrity and performance controls, may lead to more significant fines or another liability for organizational failure to implement proper operational controls. Other billing concerns may stem from Brand’s chart not being recorded accurately. Many of these may have both legal implications as well as accreditation(s) impacts.Direct or indirect causes of fraudulent billing or service provisions loud expose the organization to significant risk from litigation, fiscal and other impacts e.
G. Reputation, viability. Quo. 3. What are the ethical concerns presented in this case? Healthcare organizational success can be anchored by certain factors including technological viability, realistic resource costs, legal concerns, personnel availability, skills and expertise, and organizational goals. The ethical concerns, in this case, include information privacy and confidentiality, access, and compliance with governing laws, regulations and professional standards and guidelines related to same. In addition, there are coding compliance considerations.
Beneficence, non-maleficent, ethical decisions and related considerations and consequences are all ethical potential impacts from actions and virtues that have and may stem in this scenario. Key considerations include the release of information outside the scope of that necessary for sound business purposes may carry with it consequences Of personal and business liability. If the organization fails to be compliant with laws, rules, regulations, standards on coding, it may be negligent. The organization has to evaluate moral justification and other state or other provenance regarding any actions to override confidentiality protections e.
G. Disclosure of information may prevent a serious harm in the case of communicable disease or other.Therefore, the organizational policies and procedures should be based on the governing laws and professional guidelines such as MAIM, CACAO, and SMS. There are potential integrity, credibility, and honesty concerns if the privacy and confidentiality are not managed appropriately, and any noncompliance is not addressed and remedied. Quo. 4.
How are the ethical issues in this case covered by the American Health Information Management Association (MAIM) Code of HTH CICS? The MAIM Code of Ethics highlights the following principles related to this case: l. “Advocate, uphold, and defend the individual’s right to privacy and the doctrine of confidentiality in the use and disclosure of information. While the vignette mentions there is a lack of trust and strong collegial coordination in the department, it does not demonstrate there has been a history Of specific wrongdoing. That being said, the team and other coder should appropriately only access and disclose information needed for completing their respective job responsibilities. Brand’s privacy and confidentiality must remain the armament consideration. “Put service and the health and welfare of persons before self-interest and conduct oneself in the practice of the profession so as to bring honor to oneself, peers, and to the health information management profession. ” Notably, 2. To “act with integrity, behave in a trustworthy manner, elevate service to others above selflessness, and promote high standards of practice in every setting’ is applicable to all parties.
In particular, this and 2. 3 e. G. Conflict of interest applies to all the billing staff including Brenda. Concerning 2. 4.
“Ensure that the working environment is consistent and encourages implicate with the MAIM Code of Ethics, taking reasonable steps to eliminate any conditions in their organizations that violate, interfere with, or discourage compliance with the Code,” Shirley should be sensitive to what is driving Brand’s concerns and may need to investigate why she feels this way to be sure there are not opportunities of exposure e. G. Noncompliance, breaches. Should any evidence come to light, Shirley should address as appropriate. Preserve, protect, and secure personal health information in any form or medium and hold in the highest regards health information and there information of a confidential nature obtained in an official capacity, taking into account the applicable statutes and regulations. ” The vignette does not specify there has been a breach, but it is important to respect and investigate Brand’s concerns.
Along these lines, while there is a reference to annual confidentiality statements, there may be a need for a broader program related to same if it does not currently exist. Any breaches or other noncompliance, if present, need to be remedied. This is covered in 3.
1 detail. X. Refuse to participate in or conceal unethical practices or procedures and report such practices. Shirley will need to be sure Brand’s HAP rights are maintained as well as compliance with applicable compliant billing practices. Specifically, 4. 1, 4.
2, 4. 3 and 4. 4 apply if there is an issue with breach or potential for same. 4.
6 would apply if Brenda were to miscode or other. If a breach or other legal violation takes place, 4. 7 will apply to legal authority cooperation. “Advance health information management knowledge and practice through continuing education, research, publications, and presentations. ” While this is not necessarily core, Shirley appears to respect same as mentions an annual Taft confidentiality statement.This does not, however, confirm comprehensive reviews, refreshers and amendments as need to address relevancy an currency through a formal program that measures understanding, compliance and competency. “Facilitate interdisciplinary collaboration in situations supporting health information practice.
” The reference that the coding staff may not be collegial, Shirley may need to work with the team on this. “Respect the inherent dignity and worth of every person. ” Again, given the reference to the team and distrust, Brenda, Shirley and team need to honor and remedy this perception. Quo. 5.
Is Brand’s request to have her records sequestered appropriate, considering her distrust Of her coworkers and the delicate nature Of her health status?From an emotional perspective, Brand’s request and perceptions are understandable. The literature notes that records are typically sequestered when there is a potential for harm, actual claim or lawsuit, and special restrictions e. G. Mental health or provided the patient has made direct payment for services.
The vignette does not elaborate relative to particular concerns or violations and as such, it does not appear there is a sound case for requiring special additional precautions. In 2013, the HAP/ HITCH Final Omnibus Rule allowed for patient rights for sores control over the disclosure of their health information included in the HAP federal privacy protections.Patient’s rights include the ability to obtain health information disclosure restrictions to an insurer for payment or health care operations e.
G. Specific items and services that the patient has fully paid the provider directly. Brand’s requests do appear to fit in this category of protections. The vignette does not make clear what state or organizational regulations or guidelines may exist regarding same, so the more restrictive which provides the most patient protections typically apply. Quo. 6 What implications could be there if Shirley were to allow Brenda to code her own records while in-house and immediately after discharge. Regardless of Brand’s work status, coding her own record likely represents a conflict of interest.
If she is on sick or family leave of medical absence (FLAM), coding her own records also represents several conflicts including the aforementioned as well as potential violation of professional standards, employment protections, malpractice or negligence if working contributes to Brand’s harm or impacts her recovery and other. Coding should be objective, dispassionate and based on the facts of the case. The vignette does not reference if Community Hospital maintains electronic, paper or hybrid records but access should be appropriately limited and only done in policy designated locations and systems. Shirley needs to honor organizational protocols as well as legal and professional guidelines for same and should show no unwarranted or otherwise unjustified special treatment(s) for Brenda.Another concern relates to both the comprehensive, accurate and timeliness of the coding so as not to expose the organization ND individuals to potential fraud or other liabilities.
Quo. 7. If Brenda were allowed to code her own record while in-house, she would most likely utilize a code book rather than an encoder because she is restricted to her hospital bed. If she were to become injured from lifting the code book and/or chart what are the liability considerations for the facility. There would be significant organizational liability related to an employee working while on leave.
For instance, as the question notes, there could be potential harm, maleficent, which would represent possible negligence and/ or malpractice considerations.In addition, this may represent a workers’ compensation matter necessitating investigation with injured employee Wage replacement, medical benefits, vocational assistance or other benefits. Alternatively, there could be civil liabilities including pain and suffering general damage, employer negligence punitive damages. OSHA, CACAO, SMS and other governance entities with workplace guidelines may also be impacted and/or violated with potential penalties; e. G. Reputation, fines for violations and accreditation recognition, as not providing a safe or appropriate working environment as well as compliance with accepted tankards especially since Shirley, as an organizational leader, is complicit and aware by authorizing Brand’s efforts. Quo. 8.
Using the case method, evaluate possible actions that should take and determine the best option. What is the ethical question(s)? Is it appropriate for Brenda to code her own admission while a patient or ever? Should Shirley honor Brand’s privacy and confidentiality request for her chart sequestration? In addition, there are integrity, honesty and safe working environment concerns related to same. 0 What are the facts? o Community Hospital has a limited number of HIM staff. o There are two (2) inpatient coders. There are distrust and communication issues amongst the HIM staff. o One of the IP coders, Brenda, has had TV’0 recent hospital admissions.
On her first admission, Brenda citing concerns for her information integrity requested from her manager, Shirley, the HIM Director, that her medical record be sequestered to maintain confidentiality and that she, Brenda, be allowed to code the admission. Despite assurances that the department would be professional and maintain Brand’s confidentiality, Shirley initially agrees to sequester Brand’s record until her return to work estimated to be just one week. Brand’s condition worsened and necessitated a second admission where she again contacted Shirley with the same sequester and self coding request.
This time Brenda also indicated she would do the coding concurrently with being a patient. o Shirley explained to Brenda the inappropriateness of Brenda coding her own encounter especially while being a patient.In addition, she references the need for comprehensive chart documentation for coding accuracy and completeness that might not be met in Brand’s timeline.
A potential compliance consideration related to billing practices and provision of services which places the organization at significant risk. What are the values? o Information privacy and confidentiality (HAP), access o Quality care delivery o Professional Integrity o Conflicting priorities and potential conflict of interest o Appropriate work environment norms What are the options? 1 . Shirley supports organizational protocol and professional guidelines by having coders code Brand’s encounters.She proactively provides necessary oversight and appropriate measures to assure adherence to organizational, professional and regulatory commitments related to information privacy and confidentiality. If any concerns arise, she provides necessary course corrections and ‘or remedy.
Shirley works with appropriate parties, e. G. Legal, leadership, risk management, HER, regarding any documentation and reporting considerations and requirements. Organizational policies and procedures reviewed for relevancy and updated or amended as appropriate. Competency and compliance are measured, and communication and education regarding same is implemented.