Root Cause Analysis (RCA) is the most comprehensive method used in systematic analysis. As presented by the Joint Commission’s Sentinel Event Policy, it is a requirement that all accredited health care institutions perform a comprehensive systematic analysis in the wake of something that acts as an indicator of the presence of disease (The Joint Commission, 2015).The procedure supersedes individual practitioner performances as it targets the gaps in policy formulation and safety programs in place during an occurrence of an event. For fruition, the target of an RCA must not be to assign personal faults (The Joint Commission, 2015). On the same line, medical upcoding is a malice way of accruing unthoughtful billing on the part of the payer because of an administered health service upon a patient. An upcoded bill can reach out to any payer regardless of whether the individual is well, sick or using back up plans such as Medicaid and Medicare. Since there is no standard form of using any means, medical upcoding can happen when you get demonstrative administrations, medicinal methodology, or even while visiting a social insurance supplier ( Cram et al., 2015). The outcome of upcoding bills is an expanded expense of medicinal services for everybody because the administration and private payers impact the expense of human services on everybody. Or maybe, through the RCA decision process, a group attempts to comprehend a procedure or procedures, which postulate variety of outcomes. Therefore, using root cause analysis to investigate medical upcoding shall prompt the mistakes, and distinguish procedure changes that would make variations less prone to repeat as is the case of an assessment of a recent case study about how patients need to take subsequent actions at Mercy Vale.
For instance, while referring to the Current Procedural Terminology (CPT), Specialist "Timna" a dermatologist became a patient with multispecialty social insurance gathering to deal with her moderate hypertension and hypercholesterolemia after she resigned from her profession, thus she had to meet her internists twice a year for checkup ( Dranove et al., 2016) . Also, she had multiple actinic keratoses and non-melanoma skin malignant growths (NMSCs) that required dermatologic consideration. However, Dr. Timna found it awkward with the charging and coding related to the visits she did, even though she was previously attached to both doctors who used to attend to her. Practically all visits were coded as "99214" by her specialists, her visits, would only last for ten minute, her specialists was a medical attendant who once worked for Dr. Timna; she therefore, had acquired some information about the workplace coding. Dr. Timna, at that point, got some information about the lengths of stays and the degree of examinations and discovered that both entangled and straightforward visits were coded a similar way. Dr. Timna was worried that this synchronization was acting deceptively through upcoding.
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The most considerable impact of upcoding is the expanded expense to wellbeing payers, which are then passed on to customers. At the point when government payers end up paying over the top dollars for human services, medical coverage organizations overpay, they increase the expense of social insurance premiums to shoppers as an approach to balance the money related misfortune ( Cram et al., 2015) . On the off chance that a victim is worried about the clinic where they have gotten their therapeutic considerations, and are suspecting upcoding malice, there are a few stages that need to be taken to ensure a payer has not been charged falsely.
Therefore, to tackle unintentional or intentional medical upcoding, a patient will start by checking their Estimate of Benefits (EOB) to perceive what administrations their healthcare payer is being charged for and whether they coordinated to the particular administrations ( Ly et al., 2018) . In a like manner, it is profound that a victim takes action by contacting their provider seeking for an explanation to why their bills were not correctly summed up, should the particular diagnostic facility be responsible, then, they need to conduct their doctor and inform them on the same ( Cram et al., 2015) . In turn, they may halt future reference to the facility. Medicaid patients need to report to established offices, or in the case of Medicare patients, they have to report to their website about fraudulent behaviors. Consequently, healthcare providers, diagnostic institutions, or hospitals found guilty may face jail terms or a professional may get “laid off” (Dranove & Ody, 2016) .
While practitioners involved in medical upcoding may defend their actions behind system malfunctions and bureaucracy to spur a blame game situation, they, in turn, fail to deliver optimal care initiatives to their patients. Foremost, administrators running healthcare systems only mind their profit gains after successfully upcoding bills even by malicious professionals (Ly & Cutler, 2018) . What the stakeholders need to conceptualize is that ethically, they lead to the increased cost of health that trickles down to the consumer. For instance, as the medical bills are upcoded, the government is forced to increase taxation to sustain the excess budget for healthcare; even the insurance companies will increase the cost of premiums to counter their monetary loss.
References
Cram, P., Romley, J. A., Goldman, D. P., & Sood, N. (2015). Assessing Hospital Productivity/Hospital Productivity: The Authors Reply. Health Affairs , 34 (6), 1069.
Dranove, D., & Ody, C. (2016). Employed for higher pay? How Medicare facility fees affect hospital employment of physicians. Unpublished paper .
Ly, D. P., & Cutler, D. M. (2018). Factors of US hospitals associated with improved profit margins: An observational study. Journal of general internal medicine , 33 (7), 1020-1027.
The Joint Commission, 2015. Patient Safety Systems. Comprehensive Accreditation Manual for Hospitals. Oak Brook, IL.
