CAC Professional Ethics & Standards 3

Question 1

Which of the following best describes 'medical necessity' in EMS transport coding?

Accepted Answer

The patient's condition required ambulance transport and could not have been met by other means

Answer

Medical necessity for ambulance transport means the patient's condition required the level of care only an ambulance could provide and transport by other means would be contraindicated.

Question 2

An EMS billing coder receives a gift card from a vendor in exchange for recommending their billing software. This arrangement likely violates which law?

Accepted Answer

The Anti-Kickback Statute

Answer

The Anti-Kickback Statute prohibits offering, soliciting, or receiving anything of value to induce referrals or recommendations involving federal health care programs.

Question 3

What is the purpose of a Compliance Plan in an EMS agency?

Accepted Answer

To establish policies that prevent, detect, and correct fraud, waste, and abuse

Answer

A compliance plan creates a framework for identifying and addressing billing and operational practices that could violate laws or regulations.

Question 4

Which of the following is an example of 'waste' in EMS billing, as opposed to 'fraud'?

Accepted Answer

Consistently coding ALS transport without reviewing documentation due to time pressure

Answer

Waste involves careless or inefficient practices that result in unnecessary costs, while fraud involves intentional deception.

Question 5

What is the significance of an ABN (Advance Beneficiary Notice) in EMS billing?

Accepted Answer

It informs the Medicare beneficiary that the service may not be covered and they may be liable for payment

Answer

An ABN notifies Medicare beneficiaries before a service is rendered that Medicare may not cover it, allowing them to decide whether to proceed and accept financial responsibility.

(CAC) Certified Ambulance Coder Practice Test

(CAC) Certified Ambulance Coder Practice Test

CAC Professional Ethics & Standards 3