AAPC Practice Management & Billing Ethics

Question 1

According to the AAPC Code of Ethics, what must certified coders and billers maintain?

Accepted Answer

Accuracy, honesty, and integrity in all professional activities

Answer

The highest possible billing charges

Answer

Confidentiality only when required by law

Answer

Loyalty to employers above all other obligations

Question 2

What is 'upcoding' in medical billing?

Accepted Answer

Intentionally billing for a higher-level or more complex service than was actually performed

Answer

Using newer versions of CPT codes

Answer

Correcting code errors after submission

Answer

Using unlisted procedure codes

Question 3

What is 'unbundling' in medical billing?

Accepted Answer

Billing multiple component codes separately when a single comprehensive code should be used

Answer

Separating a bundled payment

Answer

Grouping services into one claim

Answer

Using global surgical package billing

Question 4

What is the purpose of an internal compliance audit in a medical practice?

Accepted Answer

To review billing and documentation practices to identify errors, fraud risks, and areas for improvement

Answer

To identify marketing opportunities

Answer

To negotiate payer contracts

Answer

To credential new providers

Question 5

What is 'double billing' in medical billing?

Accepted Answer

Billing two payers simultaneously and collecting from both for the same service

Answer

Billing a patient for both a co-pay and coinsurance

Answer

Using two different claim forms

Answer

Submitting claims to both Medicare and Medicaid

Question 6

What is 'phantom billing' in healthcare fraud?

Accepted Answer

Submitting claims for services, procedures, or supplies that were never provided to the patient

Answer

Billing for a service that was improperly documented

Answer

Using an incorrect provider NPI

Answer

Billing for an incorrect date of service