CAC Professional Ethics & Standards 2

Question 1

A CAC coder discovers that a colleague has been upcoding transport levels to increase reimbursement. What is the coder's ethical obligation?

Accepted Answer

Report the behavior to a supervisor or compliance officer

Answer

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?

Accepted Answer

Integrity

Answer

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?

Accepted Answer

Accessing only the PHI needed to perform a specific job function

Answer

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?

Accepted Answer

Code correctly per the documentation and document the pressure if needed

Answer

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?

Accepted Answer

Billing separately for services that should be billed under one comprehensive code

Answer

Unbundling is a fraudulent practice of billing component services separately to receive higher reimbursement than the bundled code allows.

(CAC) Certified Ambulance Coder Practice Test

(CAC) Certified Ambulance Coder Practice Test

CAC Professional Ethics & Standards 2