CAC Professional Ethics & Standards 2 — Questions and Answers
Question 1: A CAC coder discovers that a colleague has been upcoding transport levels to increase reimbursement. What is the coder's ethical obligation?
- Ignore it to avoid conflict
- Report the behavior to a supervisor or compliance officer (Correct answer)
- Match the colleague's coding practice to stay consistent
- Wait to see if an audit catches it first
Correct answer: Report the behavior to a supervisor or compliance officer
Coders have an ethical duty to report suspected fraud or abuse through proper compliance channels.
Question 2: Which principle of the AAPC Code of Ethics specifically addresses the responsibility to report inaccurate information?
- Confidentiality
- Integrity (Correct answer)
- Objectivity
- Competence
Correct answer: Integrity
Integrity requires coders to be honest and forthright, including correcting or reporting inaccurate coding.
Question 3: Under HIPAA, which of the following is considered a minimum necessary standard?
- Sharing all PHI with any provider involved in a patient's care
- Accessing only the PHI needed to perform a specific job function (Correct answer)
- Providing full medical records whenever requested by another department
- Allowing all staff to access the EHR without restrictions
Correct answer: Accessing only the PHI needed to perform a specific job function
The minimum necessary standard limits PHI access to what is reasonably needed to accomplish a specific purpose.
Question 4: A CAC coder is pressured by management to code a BLS transport as ALS to increase revenue, despite medical documentation not supporting it. What should the coder do?
- Code as instructed since management has final authority
- Code correctly per the documentation and document the pressure if needed (Correct answer)
- Split the difference and code ALS-1 instead of ALS-2
- Skip coding the claim entirely
Correct answer: Code correctly per the documentation and document the pressure if needed
Coders must code based on documentation, not financial pressure, and may need to document unethical directives.
Question 5: What does 'unbundling' refer to in EMS billing ethics?
- Combining multiple services into one code for simplicity
- Billing separately for services that should be billed under one comprehensive code (Correct answer)
- Removing duplicate charges from a claim
- Bundling several patient transports into a single claim
Correct answer: Billing separately for services that should be billed under one comprehensive code
Unbundling is a fraudulent practice of billing component services separately to receive higher reimbursement than the bundled code allows.
Question 6: Which federal law establishes criminal penalties for knowingly submitting false claims to Medicare or Medicaid?
- HIPAA
- The False Claims Act (Correct answer)
- The Anti-Kickback Statute
- The Stark Law
Correct answer: The False Claims Act
The False Claims Act imposes civil and criminal penalties on individuals or entities that knowingly submit false claims to government health programs.
Question 7: A patient's family member calls requesting information about the patient's transport and medical condition. The patient is an adult. What should the coder or billing staff do?
- Provide full details since family members always have the right to information
- Verify the patient has authorized disclosure before releasing any PHI (Correct answer)
- Provide summary information only since it is not the full medical record
- Direct them to the treating physician without acknowledging the transport
Correct answer: Verify the patient has authorized disclosure before releasing any PHI
HIPAA requires patient authorization before disclosing PHI to family members unless the patient is incapacitated or has granted prior permission.
CAC Professional Ethics & Standards 2
A CAC coder discovers that a colleague has been upcoding transport levels to increase reimbursement.
What is the coder's ethical obligation?