HIM 6018 – E-HEALTHCARE ETHICS – CASE STUDY ACTIVITIES
Internal Confidentiality Matters
Qu. 1. What internal and external forces impact Selena’s concerns in this case? The primary factors relate to Health Insurance Portability and Accountability Act (HIPAA), Privacy, accurate and appropriate coding, billing, reimbursement and compliance concerns relative to Medicare / Medicaid and CMS guidelines.
Internal forces include the following:
Community hospital with a small number of HIM staff including two (2) Inpatient (IP) coders;
Coding staff has history of distrust and lack of camaraderie; One of the IP coders, Brenda, experienced a hospitalization encounter and has requested privacy of her information from her coworkers and to have her record sequestered; Shirley, HIM director, initially commits to sequester Brenda’s record until Brenda’s return to work that might be construed as special treatment; Integrity, credibility, conflict of interest, and potential honesty values and actions related to privacy and confidentiality;
Organizational dynamics, reputation, and viability;
Adherence to appropriate ethical and principled professional guidelines concerning coding, billing practices and services rendered e.g. timeliness, conflict(s) of interest; Potential conflict of interest if Brenda were to do her coding, inappropriate place to code if Brenda is still a patient;
Coding accuracy and timeliness related to Brenda’s admissions; Completeness, competency and compliance with organizational policies and procedures for coding, privacy and confidentiality of patient’s information and designation or lack thereof for same, electronic, paper, and hybrid health record systems.; Patient counseling or lack of same concerning legal or ethical rights for medical confidentiality protections;
Existence of organizational, educational programs for employees with annual compliance checks re confidentiality;
Potential job security impacts as well as personal and professional reputation; Interdisciplinary team relations and communications;
Organizational Information Governance Policies, Procedures, and Protocols relevance and currency.
Regulatory influences including legal statutes, community standards and professional standards concerning information governance overall, compliance and appropriate billing practices.
AHIMA code of ethics, OIG – Office of Inspector General, CMS Risk of audits for billing (potential Medicare and Medicaid) Billing accuracy, timeliness, compliance and consistency.
Community standards of care and quality.
Organizational viability and community reputation.
Qu. 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 HIPAA. 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 HIPAA and CMS violations. In addition, possible litigation and OIG 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 HIPAA or other state / regulatory governance guidelines which constitute breaches of patient privacy confidentiality could potentially result in...
References: AHIMA. Code of Ethics, 1957, 1977, 1988, 1998, 2004, and 2011.
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