AAPC Practice Management & Billing Ethics 1 — Questions and Answers
Question 1: According to the AAPC Code of Ethics, what must certified coders and billers maintain?
- The highest possible billing charges
- Accuracy, honesty, and integrity in all professional activities (Correct answer)
- Confidentiality only when required by law
- Loyalty to employers above all other obligations
Correct answer: Accuracy, honesty, and integrity in all professional activities
The AAPC Code of Ethics requires members to maintain accuracy and integrity, report misconduct, and prioritize ethical practice in all billing and coding activities.
Question 2: What is 'upcoding' in medical billing?
- Using newer versions of CPT codes
- Intentionally billing for a higher-level or more complex service than was actually performed (Correct answer)
- Correcting code errors after submission
- Using unlisted procedure codes
Correct answer: Intentionally billing for a higher-level or more complex service than was actually performed
Upcoding is a fraudulent practice where a provider bills a more complex or expensive service than was documented or performed to receive higher reimbursement.
Question 3: What is 'unbundling' in medical billing?
- Separating a bundled payment
- Billing multiple component codes separately when a single comprehensive code should be used (Correct answer)
- Grouping services into one claim
- Using global surgical package billing
Correct answer: Billing multiple component codes separately when a single comprehensive code should be used
Unbundling involves billing individual components of a procedure separately to receive higher reimbursement than the single comprehensive code would provide.
Question 4: What is the purpose of an internal compliance audit in a medical practice?
- To identify marketing opportunities
- To review billing and documentation practices to identify errors, fraud risks, and areas for improvement (Correct answer)
- To negotiate payer contracts
- To credential new providers
Correct answer: To review billing and documentation practices to identify errors, fraud risks, and areas for improvement
Internal audits proactively review coding, billing, and documentation practices to catch errors and ensure compliance with regulations before external audits occur.
Question 5: What is 'double billing' in medical billing?
- Billing two payers simultaneously and collecting from both for the same service (Correct answer)
- Billing a patient for both a co-pay and coinsurance
- Using two different claim forms
- Submitting claims to both Medicare and Medicaid
Correct answer: Billing two payers simultaneously and collecting from both for the same service
Double billing is the fraudulent practice of submitting claims for the same service multiple times or to multiple payers with the intent to receive duplicate payments.
Question 6: What is 'phantom billing' in healthcare fraud?
- Billing for a service that was improperly documented
- Submitting claims for services, procedures, or supplies that were never provided to the patient (Correct answer)
- Using an incorrect provider NPI
- Billing for an incorrect date of service
Correct answer: Submitting claims for services, procedures, or supplies that were never provided to the patient
Phantom billing is a fraudulent scheme where claims are submitted for services that were never rendered, representing one of the most egregious forms of healthcare fraud.
AAPC Practice Management & Billing Ethics 1
According to the AAPC Code of Ethics, what must certified coders and billers maintain?