Anthem Education Group

Ethical Concerns in Medical Billing and Coding

Medical billers and coders work with highly sensitive personal and financial information that makes it imperative for them to maintain the highest level of ethical standards.

A Code of Ethics from the American Association of Professional Coders calls for “exemplary” personal and professional behavior from its members. Its stresses:

  • Respect for and adherence to the law
  • Maintaining the “highest standards of personal and professional conduct”
  • A no-tolerance policy for participating in or condoning “fraudulent, deceptive, or illegal acts” or exploitative behavior for personal gain
  • Pursuing professional excellence through continuing education

(American Association of Professional Coders)

Medical billers and coders must take particular care to safeguard personal health information as directed by the Health Information Portability and Privacy Act (HIPPA), which focuses on electronic communications and other avenues that share health information. HIPAA outlines who can view medical information and the steps these persons must take to ensure no part of patient files is revealed to the public.

Billers and coders who work for “covered entities,” defined by HIPAA to include insurance companies and medical providers, have a special duty to take precautions to protect patient information and ensure that it does not enter the public domain. For example, the HIPAA Privacy Rule requires that sensitive information that includes a name with a diagnosis can only be shared with personnel who need this information for the purposes of treating the patient and billing for services, or with persons the patient has explicitly authorized to receive information (Office for Civil Rights, US Department of Health and Human Services).

Billers and coders are also allies in the fight against health care fraud, which is estimated to be as high as $100 billion each year in the U.S. (Kavilanz). Billers and coders are trained to spot and highlight potential fraud, such as unnecessary services a provider bills, or instances of upcoding services.

To learn more about medical billing and coding programs offered by Anthem Education, visit our Web site.

“Code of Ethics.” AAPC. American Association of Professional Coders, n.d. Web. 19 Oct. 2010.

“Summary of the HIPAA Privacy Rule.” Office for Civil Rights. U.S. Department of Health and Human Services, May 2003. Web. 19 Oct. 2010.

Kavilanz, Parija. “Healthcare Fraud Costs Americans $100 Billion.” 13 Jan. 2010. Web. 19 Oct. 2010.

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