Medical billing and coding can offer a challenging and rewarding career, especially for those with an eye for detail and a strong sense of ethics. As part of the healthcare field, medical billing and coding specialists are expected to maintain a high degree of professionalism. If you’re considering this type of career, it’s important to understand as much as possible about medical professionalism. This knowledge helps ensure you’ll always do your job ethically, which in turn protects patient confidentiality and other sensitive information.

What Is Professionalism in Healthcare?

Professionalism in healthcare refers to certain standards that healthcare professionals are expected to uphold. These standards, such as integrity, continued improvement, compassion, and excellence, help prevent dishonest behavior or practices among healthcare professionals while also protecting the safety and confidentiality of those in their care. Medical billing and coding specialists are part of the healthcare field, making it important for them to always demonstrate a high degree of professionalism. While they might not be involved with hands-on patient care, their commitment to ethics and professionalism helps ensure patient safety.

Why Healthcare Professionalism Is Important

The main reason why healthcare professionalism is so important has to do with protecting patients and keeping them and their information safe. Professionalism among medical workers also improves the likelihood of positive health outcomes for patients. For example, physicians and nurses upholding professional standards can make informed and ethical decisions on how to provide patients with the best care. For medical billers and coders, professionalism helps ensure that patient documentation has the correct codes, so patients receive proper and timely care.

Ethical Behavior and Professionalism in Medical Billing and Coding

Working in medical billing and coding involves being familiar with the standards of professionalism and ethical behavior expected in this kind of healthcare job. Medical billing and coding specialists have access to confidential and highly sensitive patient information, making a commitment to professionalism essential. The following are some of the standards that those working in medical billing and coding should follow at all times.

Data Gathering

The way data is gathered through coding practices can become an ethical issue. Medical billing and coding specialists should always use accurate and consistent practices to gather data. All data needed for coding should be reported to ensure accuracy. These healthcare workers should follow all internal coding policies and procedures on data gathering and reporting and avoid altering or suppressing any coded information.

Accuracy

Medical coders are expected to always be accurate when coding. This means avoiding entering codes for medical services, procedures, diagnoses, or treatments that haven’t been used or done. Maintaining a high level of accuracy is one of the most important standards of professionalism for medical billers and coders. Not adhering to this standard can put these healthcare workers at risk of being accused of fraud and potentially compromise patient safety, such as if the wrong treatment or diagnosis is coded.

Misrepresenting or Changing Data

Those who work in medical billing and coding should never change or misrepresent data when coding a patient’s procedure, diagnosis, service, or treatment. If a patient or physician asks for changes to be made that do not match the clinical documentation, such as when a patient wants to make sure their insurance will cover a procedure, medical billers and coders should refuse to do so. This includes intentionally entering incorrect codes or adding codes that are not part of the patient’s documentation.

Over-Billing

Over-billing can lead to higher medical bills for patients and the possibility of having insurance companies deny reimbursement. Medical billing and coding specialists should avoid billing for services, treatments, or procedures that aren’t considered billable. Those who aren’t sure should go over the details of a patient’s care with physicians to ensure accurate billing and coding. For example, every part of a procedure might not be considered billable unless the physician states otherwise. Clarifying these complex situations with physicians helps reduce the risk of over-billing.

Bad Coding

When working on medical billing and coding, these specialists should work hard to avoid making errors or other mistakes that result in bad coding. This also includes avoiding upcoding or undercoding, such as coding for a more expensive service than what was provided or coding for a less expensive service when a more expensive one was done. Medical billing and coding specialists should avoid unbundling as well, which involves using different codes rather than one code for an entire group of procedures or treatments.

Maintaining Professional Values

Medical billing and coding specialists are expected to maintain professional values and encourage colleagues to do so as well. This might involve exposing unethical behavior that a colleague has participated in or discouraging colleagues from behaving unethically. As part of maintaining professional values, medical coders and billers should be knowledgeable about the standards of professionalism as they apply to them. They should also know the correct procedures and policies for reporting unethical behavior.

Patient Confidentiality

The Health Insurance Portability and Accountability Act (HIPAA) legally requires healthcare workers and providers to maintain patient confidentiality. In addition to this legality, protecting patients’ information is an ethical matter. Medical billing and coding specialists can see sensitive information on patients’ records, which should be kept confidential at all times. These workers should also avoid accessing any medical information that isn’t relevant to the treatment, service, or procedure they’re handling in medical billing and coding.

Honesty and Integrity

Honesty and integrity are important parts of medical professionalism. Medical billing and coding professionals should always act with integrity and honesty. This means refusing to engage in unethical practices or behaviors in coding, such as misrepresenting data, or breach patient confidentiality by looking up irrelevant patient information. Acting with integrity and honesty involves always making ethical choices on the job and maintaining high standards of professionalism, even when faced with pressure to act unethically.

Learn More About Medical Law and Ethics at CHCP

To gain a deeper understanding of medical law and ethics, consider enrolling in the on-campus or online Medical Coding and Billing Program at the College of Health Care Professions (CHCP). This program includes courses that focus on medical law and ethics. Through these courses, you can expect to learn more about professional liability, bioethical issues, legal terms, contractual agreements, informed consent, and other concepts of law and ethics in medicine. With this knowledge, you’ll be well-prepared for a career in medical billing and coding.

Looking for more information on our medical coding and billing program? Please contact CHCP today, and we’ll be happy to answer your questions and give you additional details on this certificate program.