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 is pressured by management to deny more claims to improve the company's loss ratio. Ethically, the consultant should:
Answer: Base claim decisions solely on clinical evidence and plan provisions, not financial targets
Clinical and ethical decision-making must not be driven by financial quotas; decisions must rest on evidence and plan terms.
Which federal law prohibits dental plans from making certain misrepresentations to enrollees about coverage?
Answer: The False Claims Act
The False Claims Act prohibits knowingly submitting or causing the submission of false claims or misrepresentations in federal healthcare programs.
What is 'balance billing' and why is it ethically significant in dental consulting?
Answer: Billing a patient for the difference between the dentist's fee and the plan's allowed amount when the dentist is in-network
Balance billing in-network patients violates their plan agreement and represents an ethical breach because in-network providers have accepted negotiated fees as payment in full.
A patient complains that their dental consultant denied a claim without reviewing submitted x-rays. This most directly implicates which ethical standard?
Answer: Due process and thoroughness in review
Consultants are ethically obligated to review all submitted clinical documentation before making a determination.
Under the ADA's Principles of Ethics, 'patient autonomy' means the dentist must:
Answer: Obtain informed consent and respect the patient's right to self-determination
Patient autonomy requires providing sufficient information for informed decision-making and honoring the patient's right to accept or refuse treatment.
Which of the following is an example of 'unbundling' in dental billing?
Answer: Separately billing for procedures that should be included in a single procedure code
Unbundling means separating components of a procedure that should be billed under one code to inflate reimbursement, which is considered fraud.
A dental consultant who holds certification must complete continuing education primarily to fulfill which ethical principle?
Answer: Competence and beneficence
Maintaining competence through ongoing education is essential to beneficence — ensuring decisions remain clinically sound and in patients' best interest.