Advantages and Disadvantages of Performing Medical Coding Audits Under Attorney Client Privilege

At HIA, we routinely perform audits under attorney-client privilege for our review clients. The attorney-client privilege ensures communication between a client and their legal representative remains confidential. In the realm of medical coding, where regulations and compliance are paramount, the implications of this privilege can be both advantageous and problematic. Here's a breakdown of these pros and cons in relation to the medical coding industry.

Advantages of Performing Medical Coding Audits Under Attorney Client Privilege:

  • Confidentiality: Attorney-client privilege allows a client to discuss potentially sensitive information with an attorney, secure in the knowledge it will remain confidential, as long as the purpose of the communication is to seek or provide legal advice. In the context of medical coding, this can allow healthcare organizations to freely discuss any potential compliance issues or legal concerns with their attorneys.
  • More informed decisions: The privilege enables healthcare organizations to obtain expert legal advice about their medical coding practices. By doing so, they can make more knowledgeable choices and potentially reduce future legal risks.
  • Risk Management: Amidst intricate regulatory landscapes, the privilege provides a shield, allowing organizations to receive confidential legal advice, assisting them in managing potential risks.

Disadvantages of Performing Medical Coding Audits Under Attorney Client Privilege:

  • Limited Scope: This privilege is restrictive, being applicable only to communications between the attorney and the client when the intent is seeking or providing legal advice. If such information is disseminated outside of this relationship, the protective barrier of the privilege may be breached. Within medical coding, this delineation means conversations amongst coders or other healthcare professionals are likely not protected.
  • Misuse: While the privilege is meant to protect clients, it's not immune to exploitation. Some healthcare organizations could misuse it to mask illicit or unethical activities, such as hiding fraudulent coding actions.
  • Costs: Financial implications are inevitable. Engaging an attorney for expert counsel comes at a price, a factor that might burden smaller healthcare entities.

Attorney-client privilege offers a double-edged sword for the medical coding sector. While it paves the way for uninhibited discussions and informed decision-making, it also has inherent financial limitations and potential avenues for misuse. The onus rests on healthcare organizations to judiciously employ this privilege, always keeping the broader goals of ethical practice and patient welfare in sight.

Since 1992, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.


Medical Coding Auditing Services

This article is intended to provide general information about the subject matter and should not be considered as legal advice for any specific situation or individual case. Always consult with a qualified attorney or legal professional before making any decisions based on the information presented here.

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