HIPAA and PRIVACY
What does HIPAA help protect?
Patients' protected health information and privacy.
What is Fraud?
Intentional deception for an improper benefit.
What should a coder use as the basis for assigning a code?
Medical documentation and applicable coding guidelines.
True or False:
Medical coders have a responsibility to maintain accurate records.
True.
True or False:
Medical coders have a responsibility to maintain accurate records.
True.
You finish using a patient's electronic record. What should you do?
Log out or secure the computer
A coder bills for a procedure that was never performed. Is this acceptable
No.
True or False:
A coder should guess when documentation is unclear.
False.
Why is accurate medical documentation important?
It supports patient care, coding, billing, communication, and compliance.
Your friend asks you to look up their ex- boyfriend's medical record. What do you do?
Refuse. You should not access records out of curiosity or for personal reasons.
Your friend asks about a patient treated at your office. Should you tell them?
No. Patient information should not be shared without proper authorization.
A provider asks you to use a higher-paying code that isn't supported by the documentation. What should you do?
Use the code supported by the documentation and follow compliance procedures.
You cannot determine which code is supported. What should you do?
Follow the organization's procedure for obtaining clarification or resolving the issue.
You discover an error on a submitted claim. What should you do?
Follow the organization's procedures for reporting and correcting the error.
You accidentally send patient informations to the wrong person. What should you do?
Report the incident promptly according to your organization procedures.
Why could discussing a patient in a crowded elevator be a problem?
Name TWO possible consequences of fraudulent billing.
Examples:
Financial penalties, repayment, disciplinary action, or civil/criminal consequences depending on circumstances.
You think a patient has a disease, but the provider did not document it. Should you code the disease?
No.Follow the documentation and applicable coding rules.
What is the difference between an accidental coding error and intentionally submitting false information?
An accidental error is unintentional; intentionally submitting false information involves deliberate misconduct.
Your supervisor tells you to ignore a billing error because fixing it is too much trouble. What should you do?
Follow the organization's correction and compliance procedures.
A coworker asks you to look up a patients' record because they are curious. What should you do?
Do not access the record unless there is a legitimate work related reason and authorization.
A Coworker says, "Everyone does it. The insurance company probably won't notice". Why isn't that acceptable?
Improper billing does not become acceptable because others do it. Claims should accurately reflect documented services.
Your supervisor says, "change the code. We need the insurance company to pay more". What is the ethical concern?
Coding should accurately reflect the documentation, not be changed simply to increase reimbursement.
Why must medical coders understand legal and ethical responsibilities?
Their work affects patient information,medical records, reimbursement, and compliance.
Your discover repeated billing problems. A coworker tells you to keep quiet. What should you do?
Follow the appropriate reporting/compliance process and do not participate in or conceal improper billing.