Ethical Standards of Conduct for the Medical Office

1
The Importance of Ethics in the Medical Office

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Medical practices are regulated by local, state, and federal law enforcement agencies to follow legal requirements but who regulates ethical principles?

In the medical office, it is the responsibility of leadership - the medical office manager, the physicians, administrator - to establish and enforce the ethical standards of the medical office.

The challenge with ethical principles is that there no single standard of ethical behavior to follow. Ethics is based on an individual's moral compass and what is ethical to one person is unethical to another. In order for leaders to establish and enforce ethical standards, it is best to develop a code of ethics.

2
Code of Ethics

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The code of ethics provides guidance to all employees, management, physicians, and board of directors as to what is required of them when facing ethical issues. It is necessary to ensure that the medical office conducts business and practices medicine in an ethical, lawful and honest manner.

Ethical issues include understanding and following business and healthcare ethical guidelines. Sometimes ethical issues are also considered as legal issues. Most medical office compliance policies include both ethical and legal concepts.

Some of the topics that should be included in a code of ethics include:

  • Anti-kickback and competitive conduct
  • Conflicts of interest
  • Marketing
  • Fraud and abuse
  • Chemical safety and precaution procedures
  • Accounting principles
  • Confidentiality

3
Anti-Kickback and Competitive Conduct

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The Anti-Kickback law sets provisions to identify and penalize anyone guilty of making certain health care decisions in exchange for money.

The provisions are broad but fall into two categories:

  • Any money transaction that influences the referral of an individual for any service payable under the Medicare or Medicaid program
  • Any money transaction that leads to the purchase of any item payable under the Medicare or Medicaid program

4
Conflicts of Interest

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Small physician practices are often faced with situations that may be considered as a conflict of interest. One conflict of interest could be the handling of patient payments and payment plans by the physician. Many times a physician starting out in a sole practice cannot afford to hire a full staff. Consequently, the physician and maybe one other employee are responsible for handling every aspect of the practice.

Physicians that exempt themselves from billing and collections within their practice eliminate having to make uncomfortable decisions regarding patients and financial issues.

5
Marketing

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Selling patient lists or disclosing protected health information (PHI) to third parties for marketing purposes is strictly prohibited without prior authorization from the patient. Remember that disclosure of patient information should only be accessed for the purpose of providing quality care.

6
Fraud and Abuse

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Fraud generally refers to willfully and knowingly billing medical claims in an attempt to defraud any federally funded program for money.

The most common forms of fraud and abuse include billing for equipment never provided, billing for services never performed, up-coding charges to receive a higher reimbursement rate, and unbundling charges.

7
Chemical Safety and Precaution Procedures

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Information should be communicated to the medical office staff regarding the proper safety measures for use, storage and disposal of all hazardous materials.

  1. Personal Protective Equipment (PPE): This includes safety goggles, appropriate gloves, and lab coats.
  2. Proper Labeling: Hazardous materials should never be placed in an unlabeled container. All materials should be listed on a Material Safety Data Sheet (MSDS) and be regularly updated.
  3. Follow Manufacturer Guidelines: Use appropriate method for disposal, contact to eyes or skin, or spills.

8
Accounting Principles

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General Accepted Accounting Principles (GAAP) are the common set of accounting principles, standards, and procedures that companies use to compile their financial statements. GAAP, simply put, is the customarily accepted ways of recording and reporting accounting information.

Each organization may operate differently, but all have to follow by set guidelines within the organization's community, state and at the federal level. If these standards and procedures are not followed the U.S. Security and Exchange Commission (SEC) will fine the organization and possibly pursue criminal action to enforce compliance.

9
Confidentiality

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Any organization that accesses patient health information is considered a covered entity and is required by law to comply with HIPAA provisions or face civil and/or criminal penalties. It is imperative that medical records remain confidential and cannot be accessed by people that do not have proper authorization. Disclosures made regarding a patient's protected health information (PHI) without their authorization is considered a violation of the ​Privacy Rule.