Introduction
Ethical decisions in medicine encompass not only service delivery but also financial transactions. Implementing the reimbursement process is the most challenging task for any provider, so a strategy to improve the organization’s solvency may arise. Decisions must be legal and ethical because they may yield little results and quality improvement. The most moral and right solution should be the quality and reimbursement chain assessment.
Ethical Challenges
The solution offered by the consultant is illegal and ethically wrong because it forces the financial manager to lie or embellish the cost and quantity of services. The manager is faced with the challenge of choosing a path where obtaining reimbursement through the way proposed by the consultant goes beyond the norms and principles of service delivery (Klitzman, 2016; ECI: Ethics & Compliance Initiative, 2021). Deceiving clients in the Medicaid system will not improve reimbursement or increase it because it will create additional risks not covered by the implemented solution (Coustasse et al., 2021). The principles of ethical service delivery and the code of ethics are violated, with detrimental consequences for the institution.
Options
First, one may accept the counselor’s decision, but it is ethically and legally wrong. Second, the financial manager should prejudge the administrator about such a decision and reconsider the counselor’s position in favor of violating the law and deceiving patients (Coustasse et al., 2021). Based on this, a path of risk assessment, reimbursement path, and the organization’s ability to cover costs should be chosen regarding efficiency in performing health care services. Finally, managers can shift to providing more services to fulfill the financial plan under the incentive of creating a safer system of care. A large number of diagnostic services will result in higher reimbursement gains.
Chosen Course of Action
The mission of any healthcare institution is to provide a high level of care and an optimal support system for its patients. Given the complexities of the reimbursement system, unethical options that violate the law and contribute to lower net financial management must be discouraged (Klitzman, 2016). The most promising solution would be to establish a commission to assess the risks of non-reimbursement of services, evaluate the process of service delivery, and determine the reasons why payments do not go through (Wishnia & Goudge, 2021).
The facility should integrate a reimbursement path tracking scheme and the way of receiving information from the finance department corresponding to actual treatment. In addition, patterns in the medical registrar-physician linkage should be established, as well as how the decision for a service is made. The task of the financial manager is to analyze the cause of the low payment capacity and to establish the reimbursement character, taking into account the party that is not responsible – the Medicaid system itself. Working in these areas meets the demand for ethics and performance.
Results
The decision can affect the overall payment system and improve the reliability of information. The administrator may be concerned that the decision will take a long process, but in reality, it will increase profits in the long run and bring stability back to the institution (Wishnia & Goudge, 2021). Such a solution will identify apparent deficiencies hindering the institution: quality of care, speed of data transfer from the registrar to the physician, and further down the chain to the reimbursement stage of the service (Coustasse et al., 2021). The decision can optimize this chain and improve the gaps in understanding between service providers and their implementing components.
Conclusion
When making ethically challenging decisions in management, it is necessary to rely on the legality of the chosen path and its consequences. If the solution proposed by the counselor is illegal and deceives the consumer, a decision assessing reimbursement and service quality has positive implications for the institution. Such a solution should include evaluation and analysis at various stages of the reimbursement chain, improving care strategies, and identifying gaps in information transfer processes.
References
Coustasse, A., Layton, W., Nelson, L., & Walker, V. (2021). Upcoding Medicare: Is healthcare fraud and abuse increasing? Perspectives in Health Information Management, 18(4). Web.
ECI: Ethics & Compliance Initiative. (2021). PLUS ethical decision making model. Web.
Klitzman, R. (2016). Struggles in defining and addressing requests for “Family Balancing”: Ethical issues faced by providers and patients. Journal of Law, Medicine & Ethics, 44(4), 616–629. Web.
Wishnia, J., & Goudge, J. (2021). Strengthening public financial management in the health sector: a qualitative case study from South Africa. BMJ Global Health, 6(11). Web.