CAC Professional Ethics & Standards 5

Question 1

A new EMS coder is unsure how to code a specific transport scenario and codes it incorrectly, resulting in overbilling. This is best classified as:

Accepted Answer

Abuse

Answer

Abuse refers to practices that result in unnecessary costs but do not involve intentional deception, such as errors from lack of knowledge.

Question 2

Which of the following is required to maintain the CPC-A (Certified Professional Coder – Apprentice) or CAC credential in good standing?

Accepted Answer

Completing continuing education units (CEUs) and paying annual renewal fees

Answer

Credential maintenance requires earning CEUs and paying renewal fees to demonstrate ongoing competency and professional development.

Question 3

Which scenario would most likely trigger a Medicare Recovery Audit Contractor (RAC) review?

Accepted Answer

An EMS agency with an unusually high rate of ALS-2 transports compared to regional peers

Answer

RACs use data analysis to identify billing outliers; an unusually high rate of high-level services compared to peers is a common trigger.

Question 4

What ethical responsibility does a CAC coder have when they discover their own previous coding error?

Accepted Answer

Correct the error, notify the supervisor, and resubmit or adjust the claim as appropriate

Answer

Coders have an ethical obligation to self-correct, which may include rebilling, refunding overpayments, or filing corrected claims.

Question 5

What is the role of the Office of Inspector General (OIG) Work Plan in EMS billing compliance?

Accepted Answer

It identifies areas of focus for audits and investigations that EMS agencies should monitor

Answer

The OIG Work Plan publishes annual audit and review targets, helping providers proactively assess and strengthen their compliance in those areas.

(CAC) Certified Ambulance Coder Practice Test