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 considered a 'kickback' in healthcare?
Answer: Anything of value given to induce or reward referrals of federal healthcare program business
Under the Anti-Kickback Statute, it is illegal to knowingly offer, pay, solicit, or receive anything of value to induce or reward referrals of items or services covered by federal healthcare programs.
A medical biller discovers that a physician has been consistently billing for services that were not documented. What is the biller's professional obligation?
Answer: Report the issue internally through the compliance program and refuse to submit fraudulent claims
Healthcare professionals have an ethical and legal obligation to report suspected fraud through internal compliance channels and refuse to participate in fraudulent billing activities.
What does the term 'downcoding' mean?
Answer: Assigning a lower-level code than documentation supports
Downcoding occurs when a payer or coder assigns a lower-level code than what the documentation supports, resulting in reduced reimbursement.
Which federal agency oversees healthcare fraud and abuse compliance for Medicare and Medicaid?
Answer: The Office of Inspector General (OIG) of HHS
The Office of Inspector General (OIG) of the Department of Health and Human Services is responsible for identifying and fighting fraud, waste, and abuse in Medicare and Medicaid programs.
What is the Stark Law (Physician Self-Referral Law) designed to prevent?
Answer: Physicians from referring patients to entities with which they have a financial relationship, unless an exception applies
The Stark Law prohibits physicians from referring Medicare/Medicaid patients to entities for designated health services if the physician or an immediate family member has a financial relationship with that entity.
What is a compliance program in healthcare?
Answer: An organizational framework of policies, procedures, and training designed to prevent, detect, and correct fraud, waste, and abuse
A healthcare compliance program is an internal system organizations use to ensure adherence to laws, regulations, and ethical standards, thereby preventing fraud and abuse.