CBCS Ethics and Professionalism 2

Question 1

What is upcoding in medical billing?

Accepted Answer

Assigning a higher-level code than documented to receive greater reimbursement

Answer

Upcoding is a fraudulent practice where a provider bills for a higher-level service than what was actually documented or performed, resulting in inflated reimbursement.

Question 2

Under HIPAA, which of the following is considered a covered entity?

Accepted Answer

A health plan, healthcare clearinghouse, or healthcare provider that transmits health information electronically

Answer

HIPAA covered entities are health plans, healthcare clearinghouses, and healthcare providers that conduct covered transactions electronically. Business associates that work with covered entities also have HIPAA obligations.

Question 3

What is the primary purpose of the AHIMA and AAPC codes of ethics for medical coders?

Accepted Answer

To guide professional conduct, ensure accurate coding, and protect patient privacy

Answer

Professional codes of ethics for coders emphasize accurate and complete coding, protecting patient confidentiality, avoiding fraud, and maintaining professional competence.

Question 4

A patient calls requesting a copy of their medical records. Under HIPAA, the covered entity must provide access within:

Accepted Answer

30 calendar days (with a possible 30-day extension)

Answer

Under HIPAA's Privacy Rule, covered entities must act on a request for access to PHI within 30 calendar days, with one possible 30-day extension if the entity provides written notice.

Question 5

What is the False Claims Act (FCA) primarily designed to prevent?

Accepted Answer

Fraudulent billing to federal healthcare programs like Medicare and Medicaid

Answer

The False Claims Act prohibits submitting false or fraudulent claims for payment to federal programs. It includes qui tam provisions allowing whistleblowers to file suit on behalf of the government.

(CBCS) Certified Billing and Coding Specialist Practice Test

(CBCS) Certified Billing and Coding Specialist Practice Test

CBCS Ethics and Professionalism 2