Ethics and Professionalism Flashcards
6 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Ethics and Professionalism flashcards as text
What is upcoding in medical billing?
Answer: Assigning a higher-level code than documented to receive greater reimbursement
Upcoding is a fraudulent practice where a provider bills for a higher-level service than what was actually documented or performed, resulting in inflated reimbursement.
Under HIPAA, which of the following is considered a covered entity?
Answer: A health plan, healthcare clearinghouse, or healthcare provider that transmits health information electronically
HIPAA covered entities are health plans, healthcare clearinghouses, and healthcare providers that conduct covered transactions electronically. Business associates that work with covered entities also have HIPAA obligations.
What is the primary purpose of the AHIMA and AAPC codes of ethics for medical coders?
Answer: To guide professional conduct, ensure accurate coding, and protect patient privacy
Professional codes of ethics for coders emphasize accurate and complete coding, protecting patient confidentiality, avoiding fraud, and maintaining professional competence.
A patient calls requesting a copy of their medical records. Under HIPAA, the covered entity must provide access within:
Answer: 30 calendar days (with a possible 30-day extension)
Under HIPAA's Privacy Rule, covered entities must act on a request for access to PHI within 30 calendar days, with one possible 30-day extension if the entity provides written notice.
What is the False Claims Act (FCA) primarily designed to prevent?
Answer: Fraudulent billing to federal healthcare programs like Medicare and Medicaid
The False Claims Act prohibits submitting false or fraudulent claims for payment to federal programs. It includes qui tam provisions allowing whistleblowers to file suit on behalf of the government.
Which of the following best describes the concept of 'minimum necessary' under HIPAA?
Answer: Covered entities must use or disclose only the minimum amount of PHI needed to accomplish the intended purpose
The minimum necessary standard requires covered entities to make reasonable efforts to limit PHI use and disclosure to what is necessary to accomplish the intended purpose.