J Sullivan admitted to General Hospital with chest pain, had a cardiac cath done that demonstrated significant blockage, unsent bypass and had

J Sullivan admitted to General Hospital with chest pain, had a cardiac cath done that demonstrated significant blockage, unsent bypass and had numerous post-op complications that required many returns to surgery.  He also experienced a CVA that resulted in dysphagia which led to pneumonia and respiratory failure that required ventilator support.

He was discharged from acute care and admitted to the hospital skilled nursing unit for rehabilitation.  Charges on his account were over $400000.  Hospital coders under a great deal of pressure to keep inpatient unmilled accounts under $750000.  Mr Sullivan’s account was $925000, prior to discharge and over a million when discharged.

Coding supervisor, Carma, called to meet the CFO.  He told her that he expected the Sullivan account to be coded and billed before the end of the day, as this was a critical financial time for the facility.  She assured him that she would personally take care of it.

Carma was aware of the facility’s financial situation.  Weekly analysis of accounts receivable had change to daily analysis and midday reporting of coding productivity.  Layoff rumors were  spreading and Carma, being in lower management position was in constant fear of her position being eliminated.  She felt the need to not only get the account coded but also to prove her abilities and worth to the organization to the CFO.She tracked down the chart immediately after her meeting.  Due to all the procedures and complicated diagnoses, it would take her most of the day to get the chart coded, especially without being properly assembled and analyzed first.

That morning J Sullivan was readmitted to acute care with a dissecting abdominal aortic aneurism, requiring emergent surgery.The CFO contacted Carma later in the afternoon to check the status of the account.  Carma informed hime of the situation, but he was not sympathetic and insisted that she should remain at work until the account was billed.

Patient had additional complications and additional specialists were called.  Carma made numerous attempts to get the record and was willing to work in an area in ICU.  She went to see the CFO regarding the situation, only to be told it was not his problem how she got the chart done and that he expected that account to be billed before the end of the day.

In ICU Carma encountered a physician who was very angry with her interference with the patient record and told her that financial obligations were not to interfere with patient care needs.  Carma returned to her office and got called into her director’s office.  The Director informed her that she had received a call from ICU nursing supervisor with a complaint about her interfering with patient care to get a chart for coding.  Carma explained to the director the situation and how the CFO insisted that the record be coded by the end of the day.  The director told karma that she would talk with the CFO and handle things.

The director met with the CFO and explained to him that the patient’s health situation required all the physicians to have immediate access to the health record without interference for administrative financial purposes.  The CFO did not respond sympathetically, as the director had anticipated.  The CFO told her that the financial situation was at the point where full time equivalent (FTE) reduction would be necessary and if the account was not coded and billed by the end of the day then she would be required to eliminate Carma’s position.   

Qu. 1. What internal and external forces impact this case?

Qu. 2. What are the legal issues addressed in this case?

Qu. 3. What are the ethical issues addressed in this case?

Qu. 4. How are the ethical issues in this case covered in the American Health Information Management Association Code of Ethics?

Qu. 5. Is there anything that Carma could have done differently in this case?

Qu. 6. How should the director respond to the CFO’s final statement?

Qu. 7 Using the case method, evaluate possible actions that should be taken and determine the best option.