It shall be the responsibility of every AAPC member, as a condition of continued membership, to conduct themselves in all professional activities in a manner consistent with ALL of the following ethical principles of professional conduct.
Adherence to these ethical standards assists in assuring public confidence in the integrity and professionalism of AAPC members. Failure to conform professional conduct to these ethical standards, as determined by AAPC's Ethics Committee, may result in the loss of membership with AAPC.
AAPC and its Ethics Committee does not function as a judiciary body. Any complaint to AAPC should have a foundation in law (for example, someone has been found guilty of fraud or has been placed on the Medicare Exclusion List) or a foundation in AAPC administrative rules (for example, counterfeit CEUs or a member using credentials falsely). Click here to learn how to submit an ethics complaint.
Ethical standards exist in every profession. Integrity is a key element of what every profession considers appropriate ethical behavior. In professional and/or business relationships, integrity is a much sought after trait. Certainly no physician would hire a coder lacking integrity, just as no patient would likely choose a physician lacking integrity. Similarly, coders appreciate working with co-workers and for employers who exhibit integrity.
Although it is not difficult to understand the importance of integrity in business relationships (as well as personal ones), it is sometimes difficult to determine what integrity actually is. Honesty, truthfulness, honor, dependability, and trustworthiness are all traits of those with integrity; as is upholding a moral standard of conduct in both professional and personal endeavors. Standards governing professional conduct include knowing how you present yourself, your work ethic, and how you communicate with others.
Integrity requires strong moral principles: good character, honor, and honesty. Honesty is fairly cut and dry, but "good character" and "honor" are more obtuse qualities. It may be easier to illustrate the concept of integrity through examples:
While on the clock at work, do you work diligently as your employer would expect, or do you take time out to conduct personal business? Employers expect employees to work the hours for which they are being compensated. Employees are not paid to socialize, surf the Internet, pay bills, update their Facebook status, etc. An employee with integrity will provide the level of effort his or her employer is paying for and will self-regulate work behavior. Employees acting with integrity resist the temptation to engage in non-work-related activities.
Do you cut corners and neglect workplace regulations? In healthcare, ignoring policies can lead to mistakes, noncompliance, and potentially life-threatening situations for patients. Taking shortcuts or seeking the easiest way to get through the day does not reflect a person with integrity.
Do you treat co-workers with respect? A person with integrity looks beyond his or her own interests and pursues team-centered goals. This requires polite and professional communication, appropriate interactions, and respect for the thoughts and opinions of co-workers. When disagreements arise (on coding, for example), do you objectively consider the position of your peers? Are you willing to be proved wrong? If the position of the other person is wrong, do you use the situation as an opportunity to educate or ridicule?
Integrity as a coding professional doesn’t end in the workplace. Consider these examples:
At a conference or chapter event, do you pay attention to the speaker and learn the concepts presented in exchange for the continuing education units (CEUs) you will claim? Competence is another important trait of professional behavior, and submitting CEUs should be based on your efforts to learn something. CEUs should not simply be an indicator of your presence at an educational event.
An issue impacting you arises in a blog or other social media forum. Are your comments constructive and solution-oriented, or are they purely negative? A person with integrity does not "tee off" in a public forum in a way that is disrespectful to the profession of coding, other coders, or to AAPC. Whether you disagree with an AAPC corporate decision or take issue with a forum post from another member, a person with integrity finds a way to express disagreement or dissatisfaction in a way that is not disrespectful or demeaning to others. A person with integrity also politely reminds others who have deviated from such standards that such conduct is inappropriate.
While attending an industry conference, your registration is mixed up and you do not get in the session you expected to attend. Do you berate the conference staff or do you exhibit integrity and professionally work with the individual helping you? As a similar example, if you regularly travel by air, you have likely been subject to flight cancellations. You may have observed a traveler screaming and berating the ticket agent or staff when this happens. The irate person isn’t considering that he or she is yelling at the only person that can help, and is making the situation worse for everyone.
While these examples will help you better understand the broad scope of circumstances requiring integrity, there is another dimension of this issue to consider. As part of a recent ethics committee inquiry, the following statement was made by the person being investigated to the person who was questioning the person’s conduct:
"You obviously have a high degree of integrity."
This statement begs the following question: Is integrity an all or nothing proposition or can people exhibit varying levels of integrity? If the latter, how often do you have to conform your conduct to the principles of integrity to be considered a "person of integrity?"
Is integrity like some diets where you get a cheat day? If you tell the truth most of the time does that make you truly honest? The answer to both questions is no because true integrity requires absolute adherence to an appropriate moral code and honesty requires a person always be truthful. This is a difficult standard of conduct; however, it is easier to meet than you may think. When faced with the choice of acting with integrity, you are often required to choose the harder right rather than the easier wrong. Your fellow professionals, especially those serving on the ethics committee, as well as most employers, recognize that no one is perfect. In real terms, this is a recognition that absolute integrity is something we can only strive to achieve. When you recognize lapses in judgement, how you react will ultimately define your character. In such circumstances, a person with integrity corrects the situation, learns from it, and accepts any associated penalty. Doing so will gain the respect of your co-workers and employers.
The expectation of adhering to core ethical elements sets AAPC apart from other certifying organizations. These core ethical standards assist in assuring public confidence in the integrity and professionalism of AAPC members. One of the core ethical principles of professional conduct is respect.To assess your level of respectfulness, answer the following questions:
Are you considerate of other people?
Do you treat people the way you want to be treated?
How do you react to others with different opinions?
Do you treat people with dignity, courtesy, and civility?
Do you strive to solve problems in a positive manner?
Do you intentionally ridicule, embarrass, or hurt others?
Respect is important in everyday life. We are taught respect from an early age. We are taught to respect our parents, teachers, siblings, and elders. We are taught to respect school rules, the feelings of others, family and cultural traditions, our country and its leaders, and the law. It is important for members to respect the right of others to express their opinions, including opinions differing from our own.
Self-respect is the foundation of a positive direction in life. Developing and maintaining a strong sense of self-respect can help fulfill your potential. Consistently conducting yourself in this manner will help you develop healthy relationships and will let others see you as a person worthy of respect. Respecting yourself, appreciating your own good qualities, and highlighting the positive in other people's lives will help you earn the respect of others.
Self-respect can be, in part, demonstrated by your appearance. If you seek respect, consider putting time and effort into your appearance. You should practice good grooming habits and dress neatly. Clothes do not need to be expensive; however, they should be in good condition and laundered. Practice good hygiene and take care of your health.
How you present yourself in oral and written communication is also important. Practice good grammar and use appropriate and professional language in your verbal and written communications.
Respecting the rights and privacy of others as well as the confidentiality requirements of your workplace, AAPC, or other organizations is an important reflection of your degree of professional conduct. Ethical professionals do not violate confidences or talk about others in a derogatory manner. Ethical people treat others with dignity.
Finally, professional coders should demonstrate respect for the credentials they hold and the organization to which they belong. Respecting your credentials requires continuous diligence in not only maintaining, but improving your level of professional competence. This requires meeting your continuing education requirements and challenging yourself to go beyond the minimum standards. Respect for our organization does not prohibit criticism or the free sharing of ideas, but does require you to do so constructively.
According to the Urban Dictionary's top definition, "Commitment is what transforms the promise into reality. It is the words that speak boldly of your intentions. And the actions which speak louder than words. It is making the time when there is none. Coming through time after time after time, year after year after year. Commitment is the stuff character is made of; The power to change the face of things. It is the daily triumph of integrity over skepticism."
Before you make a commitment, consider carefully the possible outcomes of your decision. A commitment obligates you to do something. Some commitments, like marriage, can be life altering. When you take a job, you're making a commitment to show up and do the job well — whether it is a paid position and your employer has committed to compensate you, or it's a volunteer effort.
Volunteering for your AAPC local chapter shows commitment to your professional growth and the development of chapter members. When we commit to membership in AAPC, we commit to "uphold a higher standard," which includes the responsibility to continually increase our level of professional competence. We commit to the AAPC Code of Ethics and the AAPC Chapter Association Code of Ethics, as well. Adherence to standards, like commitment, ensures public confidence in the integrity and service of medical coding, auditing, compliance, and practice management professionals who are AAPC members.
AAPC Chapter Association board members have the privilege of working with local chapter officers and members, as do the local chapter representatives at AAPC headquarters in Salt Lake City, Utah. In doing so, we see commitment demonstrated consistently by officers and members of our local chapters. These are the people who volunteer their time and energy to our local chapters. They are committed to the vision and mission of AAPC. They are committed to advancing the work of those who are involved in the business of healthcare by teaching, mentoring, proctoring, and supporting the members of our local chapters. Similarly, members of the AAPC advisory boards, such as the National Advisory Board, Ethics Committee, and Legal Advisory Board, make a commitment to serve the members of AAPC. Without these committed members and staff, AAPC could not function effectively.
The commitment you express to yourself, members of AAPC, and employers includes an obligation of complying to the kind of standards that exist in every professional discipline. Without these standards, we cannot represent ourselves as a professional discipline. As you consider your commitment to professional conduct, think about your willingness to enhance and improve your professional image, and the image of healthcare professionals across the globe.
AAPC's commitment to core values includes competence. This commitment is reflected in adopted principles for AAPC members to adhere to including, but not limited to:
Developing and achieving a skill set that fosters high quality, effective work product, and work process;
Maintaining credentials and coding expertise through ongoing continuing education, networking, and professional development; and
Maintaining a strong knowledge base of key principles, including an awareness and understanding of applicable laws and regulations surrounding ethical and competent, professional coding.
Competence, as defined by Business Dictionary, is "A cluster of related abilities, commitments, knowledge, and skills that enable a person (or an organization) to act effectively in a job or situation." In medical coding, competence requires more than memorizing codes or physician office habits. Rather, it requires coders to understand the premise of professional coding, to quantify (on behalf of a provider) the cognitive interaction between a provider and patient so as to describe sufficiently the encounter to the payer for reimbursement purposes.
Coding is the last link in the chain of the physician/patient interaction. It’s the last step that tells the payer why the patient presented for care, what happened, and when. Such a step requires a high level of trust by the physician that the coder comprehends his or her note describing the patient’s problems and treatment; and by the payer that the codes submitted for payment correlate with the provider’s documentation and the patient’s condition.
Competency cannot be emphasized enough. AAPC’s Ethics Committee occasionally encounters disputes involving competency. Surprisingly, such issues rarely involve actual knowledge and skill, but instead involve member conduct, where a coder knew or should have known his or her actions deviated from generally accepted standards and practices.
Taking shortcuts, not engaging in due diligence, failing to adhere to the "rules of the road," and engaging in inappropriate behavior can lead to review before the AAPC Ethics Committee panel. For example, coders should question circumstances where quantity of claims processed is more important than ensuring the codes on the claims are correct.
If elected to represent a local chapter, it is necessary to become acquainted with AAPC's Local Chapter Handbook, which covers roles, expectations, and general guidance regarding chapter finances. If designated to proctor an AAPC certification exam, it is important to remember that AAPC credentials (your credentials) are highly regarded in the healthcare industry. As such, they must be earned based on merit. Test-takers must achieve their credential(s) on their own, without the help of others. No one would seek care from a physician or advanced practice professional who cuts corners. Similarly, no one would want to leave accurate coding and reimbursement to someone who is unprincipled.
The coding profession’s role in healthcare will assume increasing importance with the transition to ICD-10 and shift from fee-for-service to value-based compensation. Such importance is reflected by the increased discussion surrounding these transformative changes.
AAPC seeks to ensure that its membership reflects the very best of competent and trustworthy professionals who can be relied on to help physicians and other providers be properly compensated for their services. The AAPC Code of Ethics should serve as a road map to all who help navigate the business of healthcare.
By Christopher A. Parrella, JD, CHC, CPC, CPCO
As members of AAPC, you are ethically and professionally responsible for treating co-workers, employers, and colleagues fairly, as well as obligated to foster an environment of fairness whether it be at work, a chapter meeting, or other professional event. The principle of fairness requires impartiality, honesty, and the disclosure of material conflicts of interest. A conflict of interest generally occurs when you're in a position to influence a decision on behalf of a particular party when your decision, more likely than not, will affect another party to whom you have a corresponding and competing loyalty.
Fairness generally involves a total disregard of personal feelings, prejudices, and desires to attain a proper balance of conflicting interests. Fairness is treating others in the same fashion you want to be treated. Fairness is at the core of all professional engagements. It's very likely that the person seeking your professional services has substantially less knowledge and training in the area of coding than yourself. You bring your knowledge and training as a healthcare business professional to establish a relationship of trust to deliver services and advice to the client. You are responsible to ensure an environment of inclusiveness and a commitment to diversity in the organization you serve.
As AAPC members, you are given the responsibility of developing, administering, and advocating policies and procedures that foster fair, consistent, and equitable treatment for all. Regardless of your personal interests, you are obligated to support and foster a corporate culture made of decisions by your organization that are both ethical and legal. It is your ethical duty to conduct yourself in a manner that equalizes your self-interests with the interests of others. To achieve this goal, you must always act impartially and objectively. When you consider each statement or action from the perspective of those on the receiving side, choosing the correct approach becomes more readily apparent.
As healthcare business professionals, we have many things for which we are responsible, which is to say, things within our control for which we are answerable or accountable. As AAPC members, we are accountable for our own professional conduct, and by living up to this obligation, we contribute to the success of our organization and our profession. We have an obligation to ensure the conduct of our colleagues is consistent with professional standards. The perception the healthcare industry has for AAPC and its members is in no small part based on the degree of professionalism we individually and collectively exhibit. It is for this reason that AAPC members are expected to uphold to ethical standards. Responsibility is a core principle in the AAPC Code of Ethics. It requires conformance with all other elements of the Code and requires every member to assist in the enforcement of the Code of Ethics.
While some think of responsibility in terms of blame (e.g., "Who is responsible for this?"), a more positive connotation is to think of responsibility in terms of opportunity. It is what allows us to exert choice and take control. A more practical definition of responsibility is the willingness to respond appropriately, regardless of the situation or the impact of doing so. Create the outcome you want through personal choices while following accepted ethical and moral rules; and recognize that each member is 100 percent responsible for the choices he or she makes.
The word “responsibility” is used in many different ways. The Merriam-Webster Dictionary defines responsibility or “responsible” as:
Liable to be called on to answer
Liable to be called to account as the primary cause, motive, or agent
Being the cause or explanation
Liable to legal review or in case of fault to penalties
Able to answer for one's conduct and obligations
Trustworthy and able to choose for oneself between right and wrong
Being responsible means considering how your personal decisions and actions may affect others, as well as you. All professionals share the obligation of being accountable for their choices and actions. Being responsible requires knowing your limitations. As healthcare business professionals, we are responsible primarily for our own work product and our own conduct. We are responsible for being competent and knowledgeable. We are responsible for giving our employers the benefit of our knowledge and advice, even though this advice may not be followed. Ultimately, we are responsible to uphold the image of our profession. We meet this obligation by controlling our own conduct and reporting instances of misconduct by others. We are accountable in both circumstances by virtue of the AAPC Code of Ethics.
Some may look at responsibility as a burden. A better approach is to look at it as an issue of trust. When you accept responsibility for something, others trust you will follow through. Employers seeking a healthcare professional place trust in you and your certification. Specifically, there is and must be trust that AAPC credentialed members possess all of the core values that our code of ethics demands: Integrity, Respect, Commitment, Competence, Fairness, and Responsibility. Your reputation is associated with the characteristics of other AAPC members. Acting irresponsibly results in a loss of trust and regaining that trust is difficult. Where one member violates the trust given by another, it not only damages the reputation of the individual, but of the profession. For this reason, a professional must always be a person holding themselves accountable for their actions and decisions. This is why AAPC members are required to comply with ethical obligations and why sanctions are imposed on those who do not conform to these standards.