CAC Professional Ethics & Standards 4

Question 1

Which of the following scenarios represents a potential HIPAA breach in an EMS billing context?

Accepted Answer

Discussing a patient's billing dispute in a public waiting room where others can overhear

Answer

Discussing PHI in a public area where unauthorized individuals can hear it constitutes an improper disclosure under HIPAA.

Question 2

A coder is asked to backdate a claim to avoid a filing deadline. This action would constitute:

Accepted Answer

Fraud

Answer

Intentionally falsifying dates on a claim to meet filing deadlines is fraud and violates the False Claims Act if submitted to a federal payer.

Question 3

What does CERT stand for in relation to Medicare claim audits?

Accepted Answer

Comprehensive Error Rate Testing

Answer

CERT (Comprehensive Error Rate Testing) is a CMS program that measures improper payment rates for Medicare fee-for-service claims.

Question 4

Which of the following best describes the ethical concept of 'non-maleficence' as it applies to an EMS coder?

Accepted Answer

Avoiding coding practices that could harm the agency, patients, or payers

Answer

Non-maleficence in coding means avoiding actions — such as upcoding or fraud — that could harm patients, payers, or the organization.

Question 5

When is a Physician Certification Statement (PCS) required for Medicare ambulance transport?

Accepted Answer

For scheduled, non-emergency transports to or from a physician's office

Answer

A PCS is required for Medicare to pay for scheduled (non-emergency) ambulance transports, certifying that the transport is medically necessary.

(CAC) Certified Ambulance Coder Practice Test