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
Which of the following best describes 'medical necessity' in EMS transport coding?
Answer: The patient's condition required ambulance transport and could not have been met by other means
Medical necessity for ambulance transport means the patient's condition required the level of care only an ambulance could provide and transport by other means would be contraindicated.
An EMS billing coder receives a gift card from a vendor in exchange for recommending their billing software. This arrangement likely violates which law?
Answer: The Anti-Kickback Statute
The Anti-Kickback Statute prohibits offering, soliciting, or receiving anything of value to induce referrals or recommendations involving federal health care programs.
What is the purpose of a Compliance Plan in an EMS agency?
Answer: To establish policies that prevent, detect, and correct fraud, waste, and abuse
A compliance plan creates a framework for identifying and addressing billing and operational practices that could violate laws or regulations.
Which of the following is an example of 'waste' in EMS billing, as opposed to 'fraud'?
Answer: Consistently coding ALS transport without reviewing documentation due to time pressure
Waste involves careless or inefficient practices that result in unnecessary costs, while fraud involves intentional deception.
What is the significance of an ABN (Advance Beneficiary Notice) in EMS billing?
Answer: It informs the Medicare beneficiary that the service may not be covered and they may be liable for payment
An ABN notifies Medicare beneficiaries before a service is rendered that Medicare may not cover it, allowing them to decide whether to proceed and accept financial responsibility.
A CAC coder finds conflicting information between the EMS run report and the hospital's triage notes regarding the patient's chief complaint. What is the best course of action?
Answer: Query the EMS crew or supervisor for clarification before coding
When documentation conflicts, the coder should seek clarification from the appropriate clinical staff rather than guessing or selecting based on financial impact.
Under the OIG's seven elements of an effective compliance program, which element involves training staff on compliance policies?
Answer: Education and training
Education and training is one of the OIG's seven elements and ensures all employees understand compliance requirements and their responsibilities.