Professional Ethics & Standards Flashcards
7 cards from real CAC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Professional Ethics & Standards flashcards as text
A CAC coder discovers that a colleague has been upcoding transport levels to increase reimbursement. What is the coder's ethical obligation?
Answer: Report the behavior to a supervisor or compliance officer
Coders have an ethical duty to report suspected fraud or abuse through proper compliance channels.
Which principle of the AAPC Code of Ethics specifically addresses the responsibility to report inaccurate information?
Answer: Integrity
Integrity requires coders to be honest and forthright, including correcting or reporting inaccurate coding.
Under HIPAA, which of the following is considered a minimum necessary standard?
Answer: Accessing only the PHI needed to perform a specific job function
The minimum necessary standard limits PHI access to what is reasonably needed to accomplish a specific purpose.
A CAC coder is pressured by management to code a BLS transport as ALS to increase revenue, despite medical documentation not supporting it. What should the coder do?
Answer: Code correctly per the documentation and document the pressure if needed
Coders must code based on documentation, not financial pressure, and may need to document unethical directives.
What does 'unbundling' refer to in EMS billing ethics?
Answer: Billing separately for services that should be billed under one comprehensive code
Unbundling is a fraudulent practice of billing component services separately to receive higher reimbursement than the bundled code allows.
Which federal law establishes criminal penalties for knowingly submitting false claims to Medicare or Medicaid?
Answer: The False Claims Act
The False Claims Act imposes civil and criminal penalties on individuals or entities that knowingly submit false claims to government health programs.
A patient's family member calls requesting information about the patient's transport and medical condition. The patient is an adult. What should the coder or billing staff do?
Answer: Verify the patient has authorized disclosure before releasing any PHI
HIPAA requires patient authorization before disclosing PHI to family members unless the patient is incapacitated or has granted prior permission.