Quality Medical Coding: Challenges & Importance in Healthcare - Essay Sample

Introduction

Quality medical coding is crucial for any healthcare facility as coded data is functional in various aspects including benchmarking, healthcare policy, research, and reimbursement among other functions. Medical coding is becoming increasingly important due to its relationship with publicly reported data and problems of quality of care. However, this increase in importance is associated with various challenges like discrepancies between coded data and supporting documentation. With time, coding professionals will be required to perform more duties and may require to involve healthcare professionals to collaborate to enhance the reliability of coded data. Therefore, the paper will examine the functional co,ponents of an integrated delivery system, ethics and ethical dilemmas, functions of health records, as well as discrepancies between supporting documentation and coded data.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

Functional Components of an Integrated Delivery System

Integrated Delivery System (IDS) is described as is an inter-connection of healthcare facilities that fall under a parent company, designed to place incentives and resources to enhance medical care quality while reducing costs (Shickel et al., 2017). The functional components of an integrated delivery system include the health education of both the family and the caregiver, health promotion and wellness, as well as primary healthcare.

Ethics and Ethical Dilemmas

Medical ethics concerns itself with assessing a given issue an applying logic, values, and facts to select the best course of action. For instance, physicians may be confronted by various puzzling ethical issues even in relatively small medical operations (Ryu et al., 2017). Some of the ethical issues include: postponing treatment to fulfill the company’s budget or due to insurance policies, the dilemma of deciding whether to accept money from device manufacturers, taking part in defensive medicine to evade lawsuits of malpractice, and the act of breaching the confidentiality of a patient. In such cases of ethical dilemmas in a healthcare setting, professional standards can be used to offer guidance.

Discuss the Purposes of Health Records

Health records play a crucial role in a healthcare facility especially in communication between healthcare personnel. For instance, documentation liaises the quality of care that patients receive and also acts as a means to enhance the continuum of care from Emergency Medicine (EM) to (Hospital Medicine (HM). Besides, health records lower risk management exposure, including the probability of being involved in malpractices. For example, a document that is properly recorded can prevent liability issues in case of a claim. Furthermore, health records serve the purpose of ensuring correct reimbursement, facilitating an efficient revenue cycle process as well as expediting payments. More importantly, health records offer an avenue for individuals to exercise their rights.

Special Roles of Health Records

The special role of health records is to ensure there is legal security of both the patient and the operator since. For health records to be used as a piece of evidence in a court of law, they need to be accurate and authentic to exercise the individual’s rights (Niles, 2019). Additionally, health records are important in terms of legal matters because they act as the basis for making liability claims. Usually, the validation of sustained damage is only premised on the evidence concerning the incident, before and after the injury. More importantly, health records are important in enhancing the comprehensive treatment of a patient, which needs even the modest change in health condition to be recorded for appropriate action to be taken.

Principal Functions of a Health Record

The principal function of health records is to ensure to makes sure there are accuracy and completeness of the diagnostic process. In this case, errors and any misalignments in the diagnostic process are identified by codes to enhance quality care for patients. Updating health records by nurses and other healthcare professionals is important for enhancing the appropriate monitoring of health plans and treatment.

Discrepancies between Supporting Documentation and Coded Data

Nurses and other medical professionals ought to be aware of the common discrepancies that may arise when documenting patient history. Failure to access or obtain information is one of the discrepancies that may occur between coded data and supporting documentation (Hawkins et al., 2018). In the case where a nurse is unable to get information about the patient directly, then he documents that he cannot access the information and also explain the reason. Furthermore, a discrepancy may also occur if there are varying levels of history (Kharrazi et al., 2018). Moreover, documenting not medically necessary items may cause discrepancies between coded data and supporting documentation. Professionals should only record what is clinically relevant to enhance the quality of care and promote billing compliance.

Conclusion

The healthcare industry is increasingly becoming data-driven and hence compelling data and information specialists to assume the central role. As a result, all clinical decisions, quality monitoring, and electronic health records are act as a direct link between healthcare professionals and the systems of gathering and processing clinical data. Therefore, therefore health records should be maintained and recorded with a high degree of accuracy to enhance reliability and patient health outcomes.

References

Hawkins, M., Pavlov, D., Burt, C., Lopez, K., & Siddiqui, K. (2018). U.S. Patent No. 10,032,236. Washington, DC: U.S. Patent and Trademark Office.

Kharrazi, H., Gonzalez, C. P., Lowe, K. B., Huerta, T. R., & Ford, E. W. (2018). Forecasting the maturation of electronic health record functions among US hospitals: retrospective analysis and predictive model. Journal of medical Internet research, 20(8), e10458. Retrieved May 29, 2020, from

https://www.jmir.org/2018/8/e10458/?utm_source=facebook.com&utm_medium=social&utm_campaign=all&utm_content=jobs+salary+information+august+2017&campaignid=70161000001lj4q&vid=2120481

Niles, N. J. (2019). Basics of the US health care system. Jones & Bartlett Learning. Retrieved May 29, 2020, from

https://books.google.co.ke/books?hl=en&lr=&id=Nf-pDwAAQBAJ&oi=fnd&pg=PP1&dq=An+Overview+of+US+Health+Care+Delivery&ots=bhA3MiTsPh&sig=FPFHpUUYT7Ct5EKmfg9bG0ajivM&redir_esc=y#v=onepage&q=An%20Overview%20of%20US%20Health%20Care%20Delivery&f=false

Ryu, B., Kim, N., Heo, E., Yoo, S., Lee, K., Hwang, H., ... & Jung, S. Y. (2017). Impact of an electronic health record-integrated personal health record on patient participation in health care: development and randomized controlled trial of MyHealthKeeper. Journal of medical Internet research, 19(12), e401.

JAMA Intern Med. 2017;177(8):1212-1213. doi:10.1001/jamainternmed.2017.1548

Shickel, B., Tighe, P. J., Bihorac, A., & Rashidi, P. (2017). Deep EHR: a survey of recent advances in deep learning techniques for electronic health record (EHR) analysis. IEEE journal of biomedical and health informatics, 22(5), 1589-1604. Retrieved May 29, 2020, from Retrieved May 29, 2020, from

https://ieeexplore.ieee.org/abstract/document/8086133