The Ethical Aspects of Medical Billing

How do you stay ethical when working in medical billing and coding? Find out here.

Our sense of ethics stems from the moral values we obtain from friends, family, religion, and other influential groups. We expect them to act a certain way as they do us.

Keeping patient information private isn't as easy as it may seem. Humans are curious and social creatures. We are nosey and like to gossip.

A small slip of the tongue can get you into trouble, and cause serious problems for the patients. How would you feel if a "little birdie" just told an acquaintance of yours that you are a recovering drug addict?

Remember: do unto others as you would have them do unto you.

Ethical considerations

  • Confidentiality

    As a medical billing specialist, you have access to very private patient information. The only persons you should discuss this information with are the patient, their physician, and their health insurance provider.

    Patient information must be protected from the eyes of unauthorized individuals. The Health Insurance Portability and Accountability Act (HIPAA) requires healthcare providers to have procedures in place to help ensure the protection of patient information.

    There are a number of ways to aid in protecting information. Use a password to protect your computer and logout before leaving your desk. If you are on the front lines and in direct contact with patients, face your computer screen away from the view of other patients and turn any paper documents face down.

    Keep any conversations regarding patient information as hushed as possible. Keep doors closed to help save information from being overheard.

  • Neutrality

    Preference for any patient or insurance company should not get in the way of your decision-making. Staying neutral is a must.

    For example:

    Your best friend was treated yesterday in your place of work. You know she has minimal health insurance and will be paying most of the expenses out-of-pocket. As a medical biller, you have direct access to the codes applied to her claim: each additional code means your best friend will have to shell out more cash.

    Here lies the conflict of interest. You want to help your best friend in her time of need, which is exactly what a best friend should feel. However, this is your job.

    Being professional and neutral are just 2 parts of being an ethical medical biller

    In this case, your best friend is now just another patient. To show her any favoritism would be unethical.

    It's imperative to follow procedure, no matter who walks through the door.

  • Honesty

    As a biller you are entrusted with medical information, collecting money, reliability, customer relations, etc.

    Violating guidelines, stealing, coding services that are not performed, unbundling procedures, and so on are unaccepted and in most cases, intolerable.

    See: fraud in medical billing.

    Inform your employer if any unethical behavior is being performed, either by a colleague, patient, or other physicians.

    Sometimes patients are addicted to certain prescriptions and may seek medical services from more than one doctor. If you discover a patient in your practice may have a questionable conduct with your office, notify the physician right away. He or she can decide how to deal with the patient.

  • Patient Rights

    Patients have the right to be treated with dignity. Many patients are in their most vulnerable state when seen in medical facilities. Treat them and their loved ones with kindness. Never belittle patients and show them respect, even when they make it hard.

    All patients have the right to privacy. When there is an issue to discuss, pull them into a secluded area away from the view (and hearing) of others.

    If you have to phone a patient and reach their voice mail, choose your words carefully - you never know who's going to hear the message.

    You wouldn't want to leave a message for Mrs. Jones telling her that her HIV test was positive, to only find out later you called the wrong number.

    Patients have the right to request certain disclosures of their medical history. For example, a patient received treatment for Chlamydia a few years back and requests for this information to be concealed whenever possible.

    Obtain all authorization documentation before disclosing any information to outside entities.

  • Professional integrity

    Professionalism is crucial when interacting with patients, insurance companies, coworkers, and anyone else you may come in contact with. When speaking with someone face-to-face or on the phone, project an outward calm and try not to get worked up when frustrations occur.

    Be sure to check that all codes are accounted for, no additional codes are added, and all the fine details of billing are complete when submitting claims.

    Keep the company in your best interest. Harsh words against your employer may do more damage than you can imagine. Billers are part of a team - everything you do directly reflects on that team.

Different associations, employers, and the government have created rules and regulations for medical billing specialists designed to ensure an ethical code of conduct in the medical world.

Physicians are responsible for their own conduct as well as the conduct of their employees within the context of employment. This is referred to as vicarious liability or respondent superior.

Physicians should implement rules and regulations regarding ethical behavior to make sure their backs are covered. Most of them do. Violations can result in write ups and loss of employment.

The government's HIPAA helps you stay ethical, as well as the AMA's Principles of Medical Ethics

A code of ethics was established by the American Medical Association in 1980, called the Principles of Medical Ethics. Although we are not bound by law to follow the code of ethics set forth by the AMA, it's a good idea to use them as a general rule of thumb.

The government created the Health Insurance Portability and Accountability Act (HIPAA) and each medical facility is lawfully bound to comply. Know the laws concerning HIPAA. If you violate them, legal action can take place in the form of sanctions and fines.

Most of us know the difference between right and wrong, and many ethical issues can be reduced to just that. Use common sense and aim to treat others with grace and dignity.

Related: the most important medical billing laws.

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