CDC Ethics & Professional Standards 2

Question 1

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?

Accepted Answer

Report the overpayment and arrange for recovery

Answer

Ethical standards require transparency; overpayments must be reported and returned regardless of who caused the error.

Question 2

Which principle of dental ethics requires that practitioners treat patients with equal fairness regardless of their insurance status?

Accepted Answer

Justice

Answer

Justice demands equitable treatment and fair distribution of dental services without discrimination based on payment source.

Question 3

A dental consultant is asked to review a claim from a personal friend's dental office. What is the most appropriate course of action?

Accepted Answer

Recuse themselves and assign the claim to another reviewer

Answer

Conflicts of interest must be avoided by recusing oneself from reviewing claims involving personal relationships.

Question 4

Under HIPAA, which of the following is an example of a permissible disclosure of protected health information (PHI) without patient authorization?

Accepted Answer

Disclosing PHI to a dental insurer for claims processing

Answer

HIPAA permits disclosure of PHI for treatment, payment, and healthcare operations, including insurance claims processing.

Question 5

A dental consultant suspects that a dentist is submitting inflated procedure codes to maximize reimbursement. This practice is best defined as:

Accepted Answer

Upcoding

Answer

Upcoding is the fraudulent practice of billing for a more expensive procedure than was actually performed.

(CDC) Certified Dental Coder Practice Test