Explain how the case has ethical challenges

Reference no: EM133434782

Medical Record Audit

You are the Release of Information Supervisor in the HIM Department. In this role, you are responsible for assuring appropriate disclosures of health information. This includes responding to medical record audit requests for Government oversight agencies. You've received a medical record request from CMS, requesting the entire medical record for several Medicare patients. The purpose of this request is to validate the medical necessity for the care and services provided during the patient stay.

Following procedure, after obtaining the requested medical records, you send the records over to the utilization review team, who is primarily responsible for coordinating patient treatment and services to maximize patient care. This team also reviews all medical records before being sent to an auditor for medical necessity review. This process helps assure that all required components are included in the medical record to support the medical necessity of the encounter.

Upon the utilization team's review, they find documentation in several progress notes inferring that the patient's actual condition didn't require the intensity of services that were provided. In other words, this documentation could invalidate the medical necessity of each visit and may result in rejection of payment for each encounter. If discovered by the auditor, the hospital will lose a lot of money. The utilization review manager has asked you to omit these progress notes from your submission to CMS so that the information is not discovered by the agency. She has assured you that "no one has to know about this and it will save the hospital a lot of trouble later on".

What will you choose to do in this situation?

Explain how the case has ethical challenges

Reference no: EM133434782

Questions Cloud

Explain skeletal muscle adaptations to strength training : Explain skeletal muscle adaptations to strength training (over time, not acute). What are the mechanisms of action? What hormones are involved

Post a brief description of your population : Post a brief description of your population and your plan for addressing their health needs. This time identify who should lead the implementation

Are conversational internet acronyms : Are conversational Internet acronyms and slang-such as AFAIK, G2G, HIFW, ICYMI, and NSFW-as well as all-lowercase writing acceptable in e-mail, texting.

Documentation of cases where ethics-emotions : Documentation of cases where ethics, emotions, and prejudices played a significant role in eroding the trust between the community and the police

Explain how the case has ethical challenges : What will you choose to do in this situation? Explain how the case has ethical challenges

Variables values good policy and theory : Using the following variables values "good policy", theory, distinguish the difference in the approach

What type of databases do you feel comfortable accessing : What are the top three skills/behaviors/attitudes that you believe you cultivated and gained in learning about evidence-based practice

How did expect dont accept shape jillians life : How do you think this type of empowerment from early-on can help a child with an intellectual disability guard against learned helplessness?

User Account

All Pages