HIM Ethical Challenges
Melinda Burns Smith, RN CPC
Western Governors University
Task Two June 2015
HIM Ethical Challenges
• This presentation will present some ethical
challenges that HIM professionals may encounter in
their professional, workday environments.
• We will be discussing the following objectives:
• 1) Describe ethical challenges in HIIM
• 2) Discuss those concerns
• 3) Describe the AHIMA Code of Ethics
• 4) Relate the sections of the code to the scenarios
Ethical Challenge: Fraud in Coding
• The coding supervisor, with RHIT
& CCS credentials, works for a
small, for-profit hospital and has
let the coding staff know they
must routinely assign higher E/M
codes than the documentation
indicates.
• Three coders, in particular, who
also hold the CCS credential, are
upset at the situation and are
told that if they don’t come onboard with it, they should look
elsewhere for jobs.
• The ethical concern is one of
fraud being perpetrated by a
person at the expense of correct
coding and damage to the coders
reputations, as well as AHIMA.
• Principle II, 2.1 and 2.4 are
violated, it instructs members to
conduct work in honorable ways.
• Principle IV, 4.1, calling for the
refusal of staff to engage in
unethical practices has been
violated by the supervisor.
AHIMA Code of Ethics. (2011)
Ethical Challenge: Staff Education
• A large hospital has employed a
new health information
management director who holds
an RHIA and CPHQ. She goes to
many meetings yearly but does
not allow her staff of six, who are
also credentialed, to go to any
educational meetings. The
volume of work is always cited as
the reason she can’t let her staff
go to educational offerings.
• The manager is not respecting
the credentials of her staff and
making it impossible for them to
meet their CEU obligations.
• This can lead to disgruntled staff
who may leave and take their
valuable training with them.
• Principle V, 5.1, 5.3, and 5.7 are
being violated here by the HIM
director. It calls for the advance of
health information knowledge
and practice through continuing
education. AHIMA Code of
Ethics. (2011)
Ethical Challenge: Delinquent Records
• An HIM graduate of three years is
newly employed at a mid-sized
facility. He is asked to compile
the chart delinquency rate and
finds some incomplete charts in a
pending file > 30 days old. He has
to choose whether to include the
older charts which would make
the delinquency higher than the
required standard by the Joint
Commission or intentionally
misrepresent the rate to make
the facility comply.
• The ethical thing to do would be
include the incomplete files in the
final report.
• If the HIM professional is not a
member of AHIMA, he may be
unaware of the code of ethics. If a
member, there may be harm to
the organization with unethical
practices.
• Principle IV comes into play here.
It addresses the refusal to
participate in or conceal unethical
practices or procedures. AHIMA
Code of Ethics. (2011)
Ethical Challenge: Unauthorized Record Access
• Alice is in the final semester of
her HIM course at a local college.
The only hospital in town has a
HIPAA compliance specialist
training program that Alice has
applied for after graduation. She
has started her Professional
Practice Experience at the
hospital and has become close
with some of the staff. She
overhears a staff rumor at lunch
regarding the illness of the
director of the Diagnostic Imaging
Center, the department where
her husband works.
After lunch, Alice returns to her
station where she pulls up the
medical record of the director,
William and sees the prognosis for
herself. At home, she convinces her
husband Brad to approach the
director with an offer to help.
William complains to the HIM
director, an audit report of logins is
run, and Alice’s login is found. She is
confronted and admits to the
unauthorized viewing of the record.
Ethical Challenge: Unauthorized Record Access
• Principle I, 1.1 has been violateduphold and defend the
individual’s right to privacy and
confidentiality.
• Principle II, 2.1 was violated-put
the welfare of persons before
self-interest.
• Principle III, 3.1 and 3.2 is
probably the most severely
violated-preserve, protect, and
secure personal health
information and hold in highest
regard the contents of records.
AHIMA Code of Ethics. (2011)
• Alice also violated HIPAA and
ARRA regulations regarding
William’s right to privacy by
accessing his record.
• She was not a direct caregiver for
the patient and had no business
being in the medical record.
• At least she did not compound
the problem by lying about the
incident.
Discussion Questions
• The ethical challenge: Fraudulent Coding
• 1) What should the CCS certified staff
members do with regards to the unethical
request?
• 2) What would happen if they were to
comply?
Discussion Questions
• Ethical challenge: Delinquent records
• 1) Should the incomplete records be included
and did the HIM graduate act appropriately?
• Ethical challenge: Staff education
• 1) Are the manager’s staff within their rights
to complain to HR about the situation?
• 2) Should they try to talk to the manager?
Summary
• Members of AHIMA agree to uphold the Code of Ethics in
daily practice and these obligations are at the heart of each
member’s responsibility, regardless of where they may work
or the collection, security and storage of health information
• “The code also prohibits HIM professionals from participating
in or concealing unethical practices…the code serves as a
guide by which individual actions can be judged.” Crawford,
M. (2011) Everyday Ethics. Journal of AHIMA 82 (4)
References
AHIMA Code of Ethics. (2011, October 2). AHIMA HIM Body of Knowledge.
Retrieved from http://library.ahima.org/xpedio/groups/public/documents
Crawford, M. ( 2011, April). Everyday Ethics. Journal of AHIMA. 82(4) 30-33
McWay, D. C. (2010) Legal and Ethical Aspects of Health Information
Management (3rd ed.) New York: Delmar