After graduation, you enter a 6-month medical office manager training program associated with a prestigious hospital. The training program consists of 3 weeks in each of various office operations. You greatly enjoyed 3 weeks performing customer service and learning about accounting functions. Your latest 3-week assignment is in the billing department. Medical bill coding is fascinating and complex. Coders are health care professionals responsible for processing patient data, such as treatment records and related insurance information. Coders translate billable information into medical codes sent to insurance. companies for proper reimbursement. A patient arrives early in the day looking absolutely miserable. Unfortunately, the patient requires treatment not covered by his insurance company. While walking past the examining room you overhear the patient say, "I can't afford paying for the medicine out of pocket." The caring doctor tells the patient not to worry, she can work around that problem. "Thanks doc," the patient says, "you're a lifesaver." Back in the bill coding department you receive the patient's documents to code. You know the patient was not treated for the illness that appears on the document and point this out to your trainer. "This happens on rare occasions," he tells you. "It's a similar illness, and the insurance companies will never know. They make a fortune from us anyway. On a few occasions they somehow find out, and we just say it was a simple mistake. The doctor has an office account that covers the amount not reimbursed to patients. Everyone does it. Just enter the code for the illness reported by the doctor.
" Critical Thinking Questions 1. What could you do? 2. What would you do? a. Enter the code for the illness reported by the doctor b. Refuse to enter the code for the illness reported by the doctor c. Something else [if so, what?) 3. Why is this the right option to choose? 4. What are the ethics underlying your decision?