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 new EMS coder is unsure how to code a specific transport scenario and codes it incorrectly, resulting in overbilling. This is best classified as:
Answer: Abuse
Abuse refers to practices that result in unnecessary costs but do not involve intentional deception, such as errors from lack of knowledge.
Which of the following is required to maintain the CPC-A (Certified Professional Coder – Apprentice) or CAC credential in good standing?
Answer: Completing continuing education units (CEUs) and paying annual renewal fees
Credential maintenance requires earning CEUs and paying renewal fees to demonstrate ongoing competency and professional development.
Which scenario would most likely trigger a Medicare Recovery Audit Contractor (RAC) review?
Answer: An EMS agency with an unusually high rate of ALS-2 transports compared to regional peers
RACs use data analysis to identify billing outliers; an unusually high rate of high-level services compared to peers is a common trigger.
What ethical responsibility does a CAC coder have when they discover their own previous coding error?
Answer: Correct the error, notify the supervisor, and resubmit or adjust the claim as appropriate
Coders have an ethical obligation to self-correct, which may include rebilling, refunding overpayments, or filing corrected claims.
What is the role of the Office of Inspector General (OIG) Work Plan in EMS billing compliance?
Answer: It identifies areas of focus for audits and investigations that EMS agencies should monitor
The OIG Work Plan publishes annual audit and review targets, helping providers proactively assess and strengthen their compliance in those areas.
When a CAC coder signs a claim form or attestation, what is the ethical significance of that signature?
Answer: It certifies to the best of the coder's knowledge that the claim is accurate and truthful
Signing a claim is a legal certification of accuracy and truthfulness; false claims signed and submitted can result in criminal liability under the False Claims Act.
Which of the following best illustrates the ethical principle of 'professional competence' for a CAC coder?
Answer: Staying current with coding guidelines, payer policies, and regulatory changes affecting EMS
Professional competence requires ongoing education and staying informed about changes in coding rules, payer requirements, and regulations.