Free The Critical Thinking Essay Sample

Hospitals use medical billing and coding system to claim medical fees from medical insurers. The system relies heavily on proper code entrance to correspond with the services provided for the claims to be valid. Bills that are wrongly coded become invalid and the medical insurers can refuse to pay the claims.   An employee of Docs R Us, Ltd made coding errors by using wrong codes in billing the procedures carried out. This means that the claims could be rejected by the medical insurer thus deny the medical facility its due payments.

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Professional ethics dictate that employees be people of high integrity, respectful, hard working, humble and devoted listeners. An employee who reacts in an angry and defensive manner after his or her mistakes are pointed out lacks humility, respect and professionalism and should, therefore, be reprimanded.

Employees may behave unethically for such reasons as selfishness, pressure, faulty reasoning, unawareness, insensitivity and lack of proper skills. For a medical facility to operate efficiently, the employees need to uphold high ethical standards. The errors that the intern committed when billing may be due to inadequate training, insensitivity and faulty reasoning. The management is, therefore, required to audit the billings of the other employees to ensure that the problem is not widespread. If other employees are found to have made the similar errors, then fresh training is needed as a remedial measure. If the errors were only made by one employee, then the management may need to review her qualifications again and find out the mistakes committed. If the errors are due to incompetence, then termination may be recommended or any other appropriate disciplinary measure.

 Erroneous billing, as noted earlier, can lead to medical claims being denied. This would, therefore, affect the quality of services provided by the hospital since lack of payments would deplete their resources. The management should, therefore, ensure that all the erroneous claims are collected and forwarded to the medical insurer in order for payments to be made. A committee should also be constituted to formulate remedial measures with the intention of preventing recurrence of the billing problems.

To ensure that the problems do not recur again, the hospital should ensure that a check system is in place in order to detect errors if they occur. They can also hire trained billing and coding professionals.


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