In this paper I’m going to talking about what AHIMA (American Health Information Management Association) and APPC(American Academy of Professional Coders) code of ethics are and the relevance that these two have to the coding profession. Then I’m going to explain how AHIMA and APPC code of ethics are incorporated into the Medical Insurance Specialist (MIS) field, and why continuing your education is important in this field. Hopefully after reading this paper you will have learned the difference between AHIMA and APPC codes of ethics.
American Academy of Professional Coders (AAPC) was founded in 1988 to provided education and professional certification to physician-based medical coders and to elevate the standards of medical coding by providing student training, certification, ongoing education, networking, and job opportunities. Since then, AAPC has expanded beyond coding to include training and credentials in documentation and coding audits, regulatory compliance, and physician practice management according to their website.
The certification process for AAPC is a coder needs to take a test that consist of 150 multiple choice questions that they have five hours and forty minutes to finish it with in. It focuses on the correct application of CPT, ICD-9 and HCPCS. To maintain certification the coder must maintain AAPC membership annul and submit proof of attending 36 hours of CEUs (Continuing Education Units) every two years. The coder can still take the test without two years’ experience but the credentials will “A” after them, which represent an apprentice.
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But they will do have a least to have two letters of verification of 2 years’ experience, including one from current employer, or supply one letter from an employer verifying 1 year of coding experience and documentation of 80 hours of approved coding education, or complete an online coding exercise consisting of 800 progress notes which must be coded with 90% accuracy. (Ross, K. Oct. 30, 2013) American Academy of Professional Coders has six certification entity codes of ethics that they like to have their coders follow and they are: •Strive to maintain and enhance the dignity, status, competence, and standards of the healthcare industry. •Maintain the highest standards of personal and professional conduct.
Members shall respect the rights of patients, clients, employers, and all other colleagues. •Use only the legal and ethical means in all professional dealings and shall refuse to cooperate with, or condone by silence, the actions of those who engage in fraudulent, deceptive, or illegal acts. •Respect and adhere to the laws and regulations of the land.
•Pursue excellence through continuing education in all areas applicable to our profession. •Ensure that professional relationships with patients, employees, clients, or employers are not exploited for personal gain. American Health Information Management Association (AHIMA) was founded in 1928 to improve the quality of health records, AHIMA has played a major role in the effective management of health data and medical records needed to deliver quality healthcare to the public according the AHIMA website.
It also going on to say that they are working to advance the performance of EHRs (electronic health records) by leading key industry initiatives and encourage high and consistent standards. AHIMA members stay one step ahead through AHIMA’s accreditation of cutting-edge academic programs and professional development opportunities, including comprehensive continuing education.
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There is a certification process for the American Health Information Management Association, it requires the coder to have high school diploma or a GED and they recommend but not required: three years’ experience in hospital-based inpatitent coding for multiple case types, three years’ experience in hospital-based coding ambulatory/outpatient coding for multiple case types, and completed coursework in A&P (anatomy and physiology), pathophysiology, and pharmacology or demonstrate proficiency in those areas.
To be certified with AHIMA, the coders will have to take a test of 60 multiple choice questions, six inpatient coding scenarios and seven outpatient coding scenarios, and to maintain this certification the coder is required to provide proof of earning 20 CEU’s (Continuing Education Units) for the past two years. (Ross, K. Oct. 30, 2013) American Health Information Management Association has eleven different codes of ethics that they like to have their members and credentialed nonmembers to follow.
Some of those ethics are: •Apply accurate, complete, and consistent coding practices for the production of high-quality of healthcare data. •Report all healthcare data elements required for external reporting purposes completely and accurately, in accordance with regulatory, and documentation standards. •Assign a report all the coders and dates that are clearly and consistently support by the health record. •Query the provider for clarification and additional documentation prior to code assignment when there is conflicting information •Refuse to change reported codes or the narrative of codes so that the meanings are misrepresented.
•Refuse to participate in or support coding or documentation practices intended to inappropriately increase payment, qualify for insurance policy coverage, or skew data by means that do not comply with federal and state rules. •Facilitate interdisciplinary collaboration in situations supporting proper coding practices. •Advance coding knowledge and practice through continuing education. •Refuse to participate in or conceal unethical coding or abstraction practices or procedures.
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•Protect the confidentiality of the record at all times and refuse to access PHI not required for coding-related activities. •Demonstrate behavior that reflects integrity, shows a commitment to ethical and legal coding practices and fosters trust in professional activities. Both American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA) follow the same general principles but they are two different ways that they are approached.
With AHIMA, their code of ethics is more practical and directive in describing the expected behavior of a coder. The eleven points detailed on the specific behaviors the coder should or shouldn’t do. And AAPC codes of ethics are an aspirational document that describes the way coders should think and decide the goal they should strive for. Hopefully after reading this paper you have learned about the differences between AHIMA and APPC and their ethical codes and why continuing your education is important when being in the Medical Insurance Specialist field.
