If an HIM department disregards official coding guidelines, what might they be committing?

When an HIM department disregards official coding guidelines, they may be committing fraud. This is because coding guidelines are established to ensure accurate and truthful representation of the healthcare services provided. If a department deliberately chooses to code services incorrectly, whether by overcoding or undercoding, this act can result in financial claims that are not substantiated by true patient care or services rendered.

Fraud involves intentional deception to secure an unfair or unlawful gain, often related to financial reimbursement from payers like insurance companies or government programs. By not adhering to established coding standards, the department could be attempting to manipulate billing practices to receive higher reimbursement rates or avoid penalties, both of which constitute fraudulent activity.

Understanding this context highlights the significance of coding compliance in healthcare. Accurate coding ensures appropriate reimbursement and maintains the integrity of health records and the healthcare system as a whole. Malpractice, while serious, typically refers to professional negligence causing harm to patients rather than issues related to coding practices specifically. Abuse usually indicates improper billing practices without the intent to defraud, and kickbacks refer to illegal payments for referrals or business, which is distinct from coding inaccuracies.