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 AAPC Code of Ethics requires members to maintain accuracy and integrity, report misconduct, and prioritize ethical practice in all billing and coding activities.

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

Upcoding is a fraudulent practice where a provider bills a more complex or expensive service than was documented or performed to receive higher reimbursement.

Question 3

What is 'unbundling' in medical billing?

Accepted Answer

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

Answer

Unbundling involves billing individual components of a procedure separately to receive higher reimbursement than the single comprehensive code would provide.

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

Internal audits proactively review coding, billing, and documentation practices to catch errors and ensure compliance with regulations before external audits occur.

Question 5

What is 'double billing' in medical billing?

Accepted Answer

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

Answer

Double billing is the fraudulent practice of submitting claims for the same service multiple times or to multiple payers with the intent to receive duplicate payments.

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

AAPC Practice Management & Billing Ethics