Module 8: Compliance & Ethics
The privacy rules governing everything you touch, the laws governing claim submission, and what to do when you are asked to code something you cannot support.
What You'll Learn
- What counts as protected health information, and the minimum necessary standard
- Recognizing a breach and the obligation to report it
- The False Claims Act, Anti-Kickback Statute, and Stark Law
- How to respond when directed to submit a claim the documentation does not support
Real-World Scenario
A provider asks you to change a 99213 to a 99215 on a note that plainly does not support it, saying the visit 'felt like a level five' and the practice is behind on revenue. Refusing is uncomfortable. Complying would make you a participant in submitting a false claim — and 'my supervisor told me to' has never been a defense.
Lessons
Complete each lesson in order. Watch the video, review the notes, and finish the challenge.
HIPAA for Billing and Coding
Understand the privacy and security obligations that govern everything a billing professional touches.
Fraud, Abuse, and Compliance
Understand the laws governing claim submission, the difference between an error and fraud, and what to do when you are asked to code something you cannot support.