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Consequences of Inaccurate Coding
Introduction
Medical coding is how services offered in healthcare are converted into billable revenue. Every service provided corresponds to its Current Procedural Terminology (CPT) and Healthcare Common Procedural Coding System codes (Hunley et al., 2021). Claims for services offered are then submitted to Medicare, Medicaid, and insurance companies in possession of these codes. The procedure and diagnosis codes are taken from clinical records such as physicians notes, radiologic, and laboratory results (Hunley et al., 2021). Sometimes inappropriate medical coding occurs that results in denials, delayed, or partially paid reimbursements (Hunley et al., 2021). This paper explores how improper coding impacts healthcare providers, public health information, patients, and the Biblical worldview on professional work ethic.
Impacts of Improper Coding on Patients
Improper coding affects patient care; every medical activity aims to offer improved care to patients. Incorrect coding can interfere with that goal resulting in frustrations, confusion, and possibly breaking patient relationship that has taken a long time to be built (Hunley et al., 2021). Although improper coding effects fall onto a patient, sometimes it happens, and it is one of the most important clinical issues that should be prevented. Therefore, incorrect coding on patients affects the level of care that a patient receives.
Failure to perform correct coding directly impacts the patients treatment. A perfect case is using an improper diagnostic code. There are variations between the specificity of codes diagnosis; therefore, improper coding when making a diagnosis might lead to incorrect patient care at another treatment or when receiving another medical service (Hunley et al., 2021). For example, coding a wrong diagnosis code can make an obstetrician withhold pain medication for an expectant woman, which might be harmful to the patient.
Improper coding interferes with patient safety because medical coding relies on consistency. Even a minor error such as interchanging two digits in a code when performing an authorization process can mean a very different diagnosis far from the expected one (Dong et al., 2021). This causes a higher probability of denials and delayed services and revenues as well as ruins the patient experience. Therefore, through improper coding, the safety of the patient is always at risk.
The other impact of improper coding on patients is that it affects client satisfaction. Inappropriate medical coding and billing affect the experience of the patient outside the office (Dong et al., 2021). This has a higher likelihood of affecting the customers reputation. For instance, a customer receiving an exorbitant bill for a treatment they never received might be viewed as a scam (Dong et al., 2021). In addition, in cases where the listed service does not match the clients claim or is not covered by the patients policy, the patient might end up in debt because of clinical errors that are unlikely to be corrected.
Impact of Improper Coding on Healthcare Providers
Incorrect coding results in decreased quality of healthcare provided by medical practitioners. The reason is that it causes piling up of administrative tasks for healthcare providers (Dong et al., 2021). As a result, their focus on the primary responsibility of rendering quality patient care is always diverted to billing because of the increased administrative tasks (Dong et al., 2021). Therefore, because of the growing burden of handling damages caused by inappropriate medical billings, medical staff would fail to offer patient satisfaction.
9 The other impact of improper coding on healthcare providers is that they are faced with increased legal issues. Medical practitioners must face legal action if they are found guilty of having provided inaccurate coding and billing information (Dong et al., 2021). Since these errors are likely to directly affect the health of the patient, healthcare practitioners behind the occurrence of such errors would be charged with monetary penalty offenses or even have their licenses revoked.
Improper coding might cause healthcare providers to be fined and also face federal penalties for committing fraud. Since improper coding results in reimbursement challenges and poor patient care, those responsible for providing improper patient care face fines and federal penalties for fraud (Dong et al., 2021). The most common outcome is always legal actions being taken on the healthcare providers or monetary penalties when the claim is named deceitful. However, to prove that the fraud happened, the coding mistakes must have happened for a long time after a long period of time. Therefore, healthcare providers found responsible for committing coding errors are fined.
The other way improper coding impacts healthcare practitioners is that it causes delayed reimbursements. When medical coding is inaccurate, they cause a persons reimbursement to be denied, get delayed or payment being made partially (Torres et al., 2021). As a result, the increased number of delayed reimbursements results in building up the paperwork, stress, and lost revenue for the emergency medicine practice to deal with.
Impact of Improper Coding on Public Health Information
Improper coding affects public health information because there might be incorrect or missing patient details. There is a presence of errors in claim denials and can be avoided by double-checking all fields before submitting a claim (Torres et al., 2021). Examples of data that can be missing are patient names, the onset of cause problems, treatment dates, information about the insurance company, and date of birth (Torres et al., 2021). Even though the information might not happen frequently, sometimes this information is entered wrongly in patients records.
Impact of Biblical Worldview on Professional Work Ethics
For Christians, Biblical Worldview means using the Bible to assist in understanding work ethics. Ethics is all about understanding and doing what is considered right and good (Evans et al., 2021). The Bible verses about hard work and ethics are easy reminders about what the Lord requires from workers. In the book of Colossians 3:23-24, the Bible encourages people to work heartedly, as for the Lord, with full understanding that from the Lord, there is inheritance as the main reward (Evans et al., 2021). The reason is that people ought not to focus on serving humanity but on Lord Christ (Evans et al., 2021). Additionally, the Bible advocates for honesty in everything, thus, improper coding by a healthcare professional is highly forbidden.
Conclusion
Conclusively, this paper has explored various ways that improper coding affects the patients, healthcare providers, public health information, and the biblical worldview on the professional work ethic. Some ways that patients are impacted by improper coding is that it affects patient care, interfering with patient safety, and affecting patient satisfaction. Healthcare providers are also affected in that it diverts their attention, making them provide low-quality care to patients, they are faced with increased legal issues, they are also faced with federal penalties for fraud and abuse. The Biblical worldview on professional work and ethics is that employees should learn to perform their duties as though they are serving Christ and work honestly in everything that they do.
References
Dong, H., Suárez-Paniagua, V., Whiteley, W., & Wu, H. (2021). Explainable automated coding of clinical notes using hierarchical label-wise attention networks and label embedding initialisation. Journal of Biomedical Informatics, 116, 103728.
Evans, C., Brown, D., & Davis, J. (2021). Professional counseling from a Christian worldview. Journal of Spirituality in Mental Health, 1-18.
Hunley, C., Murphy, S. M., Bershad, M., & Yapici, H. O. (2021). Utilization of medical codes for hypotension in shock patients: A retrospective analysis. Journal of Multidisciplinary Healthcare, 14, 861.
Torres, C., Ogbu-Nwobodo, L., Alsan, M., Stanford, F. C., Banerjee, A., Breza, E., & COVID-19 Working Group. (2021). Effect of physician-delivered COVID-19 public health messages and messages acknowledging racial inequity on black and white adults knowledge, beliefs, and practices related to COVID-19: A randomized clinical trial. JAMA Network Open, 4(7), e2117115-e2117115. doi:10.1001/jamanetworkopen.2021.17115
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