Ethics & Professional Standards Flashcards
7 cards from real CDC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Ethics & Professional Standards flashcards as text
A dental consultant discovers that a claim was paid in error due to a coding mistake made by the insurance company. What is the ethical obligation?
Answer: Report the overpayment and arrange for recovery
Ethical standards require transparency; overpayments must be reported and returned regardless of who caused the error.
Which principle of dental ethics requires that practitioners treat patients with equal fairness regardless of their insurance status?
Answer: Justice
Justice demands equitable treatment and fair distribution of dental services without discrimination based on payment source.
A dental consultant is asked to review a claim from a personal friend's dental office. What is the most appropriate course of action?
Answer: Recuse themselves and assign the claim to another reviewer
Conflicts of interest must be avoided by recusing oneself from reviewing claims involving personal relationships.
Under HIPAA, which of the following is an example of a permissible disclosure of protected health information (PHI) without patient authorization?
Answer: Disclosing PHI to a dental insurer for claims processing
HIPAA permits disclosure of PHI for treatment, payment, and healthcare operations, including insurance claims processing.
A dental consultant suspects that a dentist is submitting inflated procedure codes to maximize reimbursement. This practice is best defined as:
Answer: Upcoding
Upcoding is the fraudulent practice of billing for a more expensive procedure than was actually performed.
Which ADA Principle of Ethics addresses the dentist's duty to keep professional knowledge and skills current?
Answer: Beneficence
Beneficence encompasses the duty to act in the patient's best interest, which includes maintaining competence through continuing education.
A dental consultant receives a gift from a dental practice whose claims they regularly review. According to professional ethics, the consultant should:
Answer: Decline the gift to preserve objectivity and avoid conflicts of interest
Accepting gifts from parties whose claims you review compromises impartiality and violates conflict-of-interest standards.