Ethical Case Study: Coding Backlog

by | Jul 24, 2024 | ethics

Ethical Case Study:
Coding Backlog
Mary is a coding supervisor at a community healthcare organization. Due to an increase in patient volumes and an increase in coding staff turnovers, the coding unit is experiencing a heavy backlog in outpatient accounts that need coded. This backlog is resulting in an estimated $8 million in unbilled accounts that the facility needs to seek reimbursement for. This is critical to the operations of the organization as they are potentially facing bankruptcy in the near future.
In order to quickly get caught up and obtain reimbursement, Mary’s manager, Sandy has directed all coders to code the first diagnosis seen on the first page of the chart, rather than reviewing all of the documentation in the encounter for additional diagnoses that may increase revenue for each encounter.
Mary voices her concerns to Sandy that this may result in under-coding. If the coders could take the time to review the full documentation, they could maximize the potential amount of reimbursement for each encounter. Sandy argues that the coders do not have time for that and need to focus more on getting the charts done rather than checking for additional diagnoses. Sandy accuses Mary of being disobedient to Sandy’s authority and threatens disciplinary action if Mary does not comply with her instructions.
What should Mary do?

Answer the following questions for the scenario selected:
Scenario 1:
1. Identify whether there is an ethical concern, and if so, what the ethical concern is.
2. Determine how the scenario should be handled. For instance, if you were the leader in the selected situation, how would you manage the issue?
3. Recommend course(s) of action to be taken.
Scenario 2:
1. Identify whether there is an ethical concern, and if so, what the ethical concern is.
2. Determine how the scenario should be handled. For instance, if you were the leader in the selected situation, how would you manage the issue?
3. Recommend course(s) of action to be taken.
Scenario 3:
1. Identify whether there is an ethical concern, and if so, what the ethical concern is.
2. Determine how the scenario should be handled. For instance, if you were the leader in the selected situation, how would you manage the issue?
3. Recommend course(s) of action to be taken.
Conclusion
1. Compare/contrast the three cases selected. In what ways are the ethical concerns similar? Different?
2. Interpret/discuss the ethical theory or theories that would best apply to the recommended courses of action for each scenario.
3. Develop steps for a leader to follow to assist with the ethical-decision making process.

 

 

 

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

Sample Answer

Sample Answer

 

Ethical Case Study: Coding Backlog

Scenario 1

1. Ethical Concern

The ethical concern in this scenario revolves around the potential for under-coding, which can lead to significant revenue losses for the healthcare organization and compromise the accuracy of patient records. By following Sandy’s directive to only code the first diagnosis listed, coders may not be accurately reflecting the patient’s condition or the services provided. This approach may violate ethical standards related to honesty, integrity, and accountability in medical coding practices, as it could lead to financial misrepresentation.

2. Handling the Scenario

As Mary, the coding supervisor, I would need to address this issue with a focus on maintaining ethical standards while also considering the operational pressures faced by the organization. I would first gather evidence of how under-coding could impact both patient care and financial health. This includes data on potential revenue loss due to the lack of comprehensive coding.

3. Recommended Courses of Action

– Document Concerns: Record specific instances where following Sandy’s directive could lead to under-coding and potential revenue loss.
– Request a Meeting: Arrange a formal meeting with Sandy to discuss my concerns about under-coding. Present data and examples that illustrate how reviewing full documentation can optimize revenue without compromising care quality.
– Propose a Compromise: Suggest a balanced approach where coders can prioritize urgent cases but still review additional diagnoses when time permits.
– Escalate if Necessary: If Sandy remains unyielding, consider escalating the issue to higher management or seeking guidance from the compliance officer regarding ethical coding practices.

Scenario 2

1. Ethical Concern

The ethical concern here is rooted in the conflict between operational efficiency and ethical coding practices. Sandy’s directive prioritizes speed over accuracy, which could lead to both financial strain on the organization and ethical violations in patient care documentation.

2. Handling the Scenario

As a leader in this situation, I would prioritize open communication and foster an environment that values ethical decision-making. I would sit down with Sandy to express my concerns while emphasizing our shared goal of supporting the organization’s sustainability.

3. Recommended Courses of Action

– Conduct a Risk Assessment: Evaluate the potential risks associated with under-coding and document findings to present to Sandy.
– Educate on Compliance: Provide information on industry regulations and best practices for coding accuracy, stressing that compliance is essential for long-term organizational health.
– Collaborative Strategy: Work together with Sandy to develop a plan that allows coders to maintain thoroughness while addressing the backlog—perhaps by hiring temporary coders or utilizing overtime effectively.

Scenario 3

1. Ethical Concern

The ethical concern here involves the potential retaliatory action against Mary for voicing her professional opinion about coding practices. Sandy’s threat of disciplinary action could create a culture of fear among employees, discouraging them from speaking up about unethical practices, which is detrimental to both workplace morale and patient care.

2. Handling the Scenario

As a leader, it is critical to uphold an ethical workplace environment where employees feel safe to voice concerns without fear of retaliation. I would emphasize the importance of fostering an open dialogue about ethical issues in coding.

3. Recommended Courses of Action

– Implement Whistleblower Protections: Advocate for policies that protect employees who report unethical practices from retaliation.
– Create an Open Forum: Develop regular meetings where staff can share concerns about practices in a safe environment.
– Document Everything: Keep records of all communications related to this issue for accountability and transparency.

Conclusion

1. Comparison of Ethical Concerns

The ethical concerns across all three scenarios focus on maintaining integrity in medical coding practices, ensuring accurate documentation, and creating an environment where employees feel safe to express their concerns. While Scenario 1 emphasizes the immediate consequences of under-coding on revenue and patient care, Scenario 2 highlights the broader implications of compliance with industry standards. Scenario 3 underscores the importance of protecting employees from retaliation when they raise ethical concerns.

2. Ethical Theory Interpretation

The ethical theories applicable to these scenarios include:

– Deontological Ethics: Emphasizes duty and adherence to rules; in this case, following accurate coding practices is an ethical obligation.
– Consequentialism: Focuses on the outcomes of actions; under-coding can result in negative consequences for patient care and the organization’s financial health.
– Virtue Ethics: Encourages fostering virtues such as integrity, transparency, and accountability within the organization.

3. Steps for Ethical Decision Making

1. Identify the Ethical Dilemma: Recognize the ethical issue present in the coding process.
2. Gather Information: Collect relevant data regarding coding practices and potential consequences.
3. Consult Stakeholders: Engage with involved parties to understand different perspectives on the issue.
4. Evaluate Alternatives: Consider various options for addressing the backlog while maintaining ethical standards.
5. Refer to Guidelines: Consult organizational policies and industry regulations regarding coding practices.
6. Make an Informed Decision: Decide on a course of action that aligns with ethical principles.
7. Communicate Decision: Clearly communicate the decision and its rationale to all relevant stakeholders.
8. Reflect on Outcomes: Assess the results of actions taken and learn from them for future ethical decision-making.

By implementing these steps, leaders can navigate complex ethical dilemmas while fostering a culture rooted in integrity and accountability within their organizations.

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