Practice Management & Billing Ethics Flashcards
6 cards from real AAPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Practice Management & Billing Ethics flashcards as text
According to the AAPC Code of Ethics, what must certified coders and billers maintain?
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.
What is 'upcoding' in medical billing?
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.
What is 'unbundling' in medical billing?
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.
What is the purpose of an internal compliance audit in a medical practice?
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.
What is 'double billing' in medical billing?
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.
What is 'phantom billing' in healthcare fraud?
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.