You have been working for a physician in private practice for 8 months. You start to see a pattern with several of his workers’ compensation cases. Each of these patients seems to have more tests and procedures ordered than others with similar conditions. One day the physician asks you to complete and send a billing claim to the insurance carrier for a procedure that you do not think he performed. What are your responsibilities, and what would you do?

Answers

Answer 1

Answer:

I have been working for a physician who is in a private practice for 8 months. I have started to see a pattern with several of his workers' compensation cases. The patient's seem to have more tests and procedures ordered than others with similar conditions. The physician asks me to complete and send a billing claim to the insurance carriers but its for a procedure that I don't think he has performed.

So what would be my responsibilities, and what should I do?

Explanation:

Workers compensation fraud (or filing false claims) is not only unethical, it is considered a crime.

If you suspect a provider is committing insurance fraud, even if they are your employer, you should report it. If you are a participant and knowingly file claims that you know or suspect are fraudulent, you can be implicated. You are especially at risk if there is evidence that you knew the workers comp claims being submitted were fraudulent. In many situations filling false claims can be punishable with jail time.

Keep good documentation and records with names, dates, and any other specifics. Remember this is also for your own protection.

If the doctor is verbally telling you to bill for charges - I couldn't or do that. When a biller knowingly and willingly participates in insurance fraud - they are guilty also.

Hopefully all the procedures your provider is telling you to bill for are documented - on something like a superbill or his patient encounter notes - evidence that shows the provider performed the procedure(s). In a situation like this it’s important to protect yourself and make sure there’s nothing the doctor can blame you for if he gets accused of fraud - or prosecuted.

Ultimately the doctor is morally and ethically responsible for the procedures he performs - or says are performed. We (the biller) are not in the exam room to know what the doctor did or didn’t do. But as a medical biller I feel I have an ethical obligation to report flagrant and obvious fraud when the temptation may be to look the other way.

I understand the dilemma is that if the biller reports this to the insurance carrier, they put their job in jeopardy. Of course if the doctor really is committing fraud it makes you wonder if you really want to work there - if you really want to work for someone with questionable ethics. They will eventually get caught.


Related Questions

The Stages of Grief include all of the following EXCEPT: A. Focusing on the positive B. Anger C. Bargaining D. Acceptance

Answers

Hope this helped, please mark brainiest!

what does KFC stand for​

Answers

Answer:

Kentucky Fried Chicken

Explanation:

kentucky fried chicken !!!!

yuummmyyy

what is a definite sign of over training

Answers

Answer:  The lack of improved performance, despite an increase in training intensity or volume. Decreased agility, strength and endurance, such as slower reaction times and reduced running speeds are all common signs of overtraining.

Explanation:

Which of the following shows the correct order
of how sound travels through the ear?
A) Pinna, tympanic membrane, ossicles,
cochlea, cochlear nerve
B) Auditory canal, ossicles, cochlea, vestibular
nerve
C) Pinna, tympanic membrane, vestibule,

Answers

Answer:

The answer to your question is C) Pinna, tympanic membrane, vestibule,

Explanation:

Facts you might find useful

The auricle (pinna) is the visible portion of the outer ear. It collects sound waves and channels them into the ear canal (external auditory meatus), where the sound is amplified. The sound waves then travel toward a flexible, oval membrane at the end of the ear canal called the eardrum, or tympanic membrane.

Tina is caring for an infant who is running a very high fever and vomiting whenever Tina tries to feed him some water to keep him hydrated. If she continues to give him water to try to lower his body temperature and increase hydration and, as a result, he vomits more fluid than he is drinking, then he will only get more dehydrated, and his body temperature will rise. What do you think Tina should do to reduce the child’s fever, make him more comfortable, and enhance his ability to drink liquids?

Answers

Answer: Tina should worry about the fever first and get a ice pack or a cool rag to get him to his normal temperature. Doing that will make him comfortable...well at least a little. The child has pyrexia so medications such as acetaminophen and ibuprofen may help ease discomfort. Since this is a child, avoid giving him aspirin because this may cause a rare, serious condition.

2. Write down the
main function of arteries
and veins​

Answers

Basically the main function of both of these has to do with blood. Arteries are important because they move blood away from the heart. Veins do the opposite of arteries and actually return blood back to the heart! They are both very important for the body.

What is the suggested carbohydrate intake for male clients per meal?
A. ( ) 2 palm portions
B. ( ) 2 cupped handfuls
C. ( ) 1 cupped handful
D. ( ) 1 palm portion

Answers

i think it’s 2 cupped handfuls

Answer:

2 cupped handfuls

Explanation:

Which is a primary risk factor for developing cancer?

A. Active immune system
B. Lack of iron in the diet
C. Lack of calcium in the diet
D. Workplace Exposure​

Answers

Answer:

I think the answer is b or c

Answer:

ik im late but the answer is d workplace exposure

Explanation:

Please mark me as brainest. And I hope you are all doing well and staying safe during these crazy times. You know...I was looking at this great movie yesterday and I thought of the world and what's happening right now. And I thought to my brain a bit and said....together or far...we are Americans. Nothing will kill us because we are strong.
God bless you all! And make all your wishes come true.
Please mark me as brainest.
With love,
Olvin Otero

Answers

Answer:

love u too awnnnnnnnnn

Answer:

Wow, that gave a lot of emotion..

Explanation:

According to the ChooseMyPlate you should get the majority of your grain requirements from refined products such as white rice and white bread. (4 points)
True
False

Answers

The answer would be false
False.
The majority of your grain serving should come from whole grains, the other grain group.
From the Mayo Clinic;
“All types of grains are good sources of complex carbohydrates and some key vitamins and minerals, but whole grains — the healthiest kinds of grains — in particular are an important part of a healthy diet.”

What are the two main types of defense taught in basketball?
Man, and Zone
Man to Man, and Individual

Answers

Answer:

Man and Zone

Explanation:

I play basketball and was captain, this is correct trust me

Organizing the information in a news release so that the important information comes first is called ?

Answers

Answer:

S

Explanation:

A ______ should be included at the beginning of each workout.

Answers

Answer:

Stretching session

Explanation:

You should always stretch before you workout.

Afferent pathways send information from the site of the problem to which body system? O A. Central nervous system B. Muscular system O C. Skeletal system D. Respiratory system​

Answers

Answer:

A

Explanation:

the awnser is A

there ya go

Answer:

Central nervous system

Explanation:

(Not for school, personal question) I am a 14 yr old, 15 in January. I lift weights and stick to a diet, recently I haven't been working out due to a hip injury that is healing slowly but surely. I have been using whey protein powder after workout, not to much as I know it is unhealthy for you (32 grams with plenty of water). I just recently found out about vegan protein and heard it is healthier then whey, not sure if I should switch to vegan or whey, opinions? I apologize for any typos, currently on mobile.

Answers

Answer:

For me, I am not a vegan. But you should honestly do whatever your heart tells you to do. You can stick to eating meat while you ate using a protein, you honestly do not have to switch to vegan, it would not make much of a difference. :)

Explanation:

hope this help. keep being strong, and do whatever your heart says.

• Create one other walking-related goal that you would like to accomplish by the end of the semester.

Answers

Answer:

Walking is a great way to increase fitness. When setting goals of any kind it’s important to understand where point “A” is first. Access your current walking fitness level. How long can you walk? What is your intensity level, best measured by the percentage of your maximum heart rate?

Then set a SMART goal.

Specific

Measureable

Attainable

Relevant

Time Sensitive

When setting a goal it must be precise, something you can quantify, something within reach, significant to you and you must set a completion date so you know when your goal has been met. I would recommend setting a long-term goal that gets you excited. Perhaps this is to walk in a local 5k charitable event. Once the long-term goal has been established, set a few shorter, interim goals so you can celebrate progress along the way. Perhaps this is when you reach your first mile. Or walk for 30 minutes. Or walk at an intensity equal to 70% of your maximum heart rate.

And finally, reward yourself for a job well done.

Explanation:

The initial questions you have to ask yourself are:  1. What is my primary goal, weight loss, improved cardiovascular endurance, general conditioning, or all of the above?  2.  What is my current fitness level, do you exercise 0 times per week, 1-2, 3-4, or 5+?  3.  How much time to you have to devote to exercise, 15-20 minute spurts, 30-45 minutes, 60+ minutes?  After answering those questions you can then set a realistic goal.  To give an example, if you exercise 3-4 times per week and are able to devote 30-45 minutes of walking then you can feasibly push to complete 2-3 miles of which should allow time for a pre/post stretch.   All of this would be completed at a comfortable pace of walking a mile in 15:00 minutes or less.  Be sure to answer the initial questions and proceed from there.  Lastly, another way to figure out how to set a realistic goal would be to purchase a pedometer and go out for a walk, 2,000 steps is approximately 1-mile.

2.
The IUPAC name of the compound represented
by the structure below is
H
СІ
H
C =c- c = c.
H
H​

Answers

Answer:

the structure was not clear

Explanation:

i guess it is chlorobut-1,3-ena

Paralytic ileus usually occurs in the:

Answers

Bacon cheeseburger with extra cheese
An ileus occurs when the intestines do not move food through in the normal way. It often occurs after abdominal surgery. This is a severe condition because, if left untreated, an ileus can cut off blood supply to the intestines and cause tissue death.

what does this say about the brain capacity and capabilities differences between the sheep and human?

Answers

Answer:

The sheep's brain has a more developed olfactory bulb when compared to the human brain

Explanation:

An object has a density of 40 g/cm³ and a mass of 240 g. What is its volume?

Answers

Answer:

6 cm cubed

Explanation:

Loss of __________ is a key indicator of heat stroke.

Answers

Answer:

headache

Explanation:

It's a key indicator of heat stroke

Which are risk factors for su!c!de? Select four options.

mental health disorders
substance abuse
side effects from medications
having a relative who is su!c!dal
experiencing a minor change in life

Answers

Answer:

-mental health disorders

-substance abuse

-side effects from medications

-having a relative who is suicidal

Explanation:

All of them are factors except for experiencing minor change in life.

What are five ways companies target teens and vaping?

Answers

Answer:

interesting flavors is one way. they also advertise them by saying they're healthy. they also advertise them by having teenagers use them in advertisements. they can also advertise them by showing how easy it is to hide or carry around.

the flavors and the packaging and the cools tricks you can do with them hope this helps

BDFD Report
50 points
Complete the following data. The data will be used to assess the accuracy of the calculations below. Please note that your
data will be kept confidential. If you prefer, you may provide made-up information - just make sure you use the
information correctly to answer the questions. Each measurement is worth one point, so this is an easy way to get points!
Height
Weight:
Age:
Gender:
Physical Activity Factor or Lifecycle Factors (i.e. pregnancy, lactation):
Answer the following questions.
c.
1.
[3 points] How many calories per day should you consume?
a. Convert weight in pounds to weight in kilograms.
b Convert height to meters.
C Use EER equation and PA factor from chapter 9, slides 18-19 to calculate calories per day.
2. [3 points) How many grams of protein per day should you consume?
а. Convert weight in pounds to weight in kilograms.
b. Identify how many grams of protein per kilogram of body weight is appropriate
Calculate total grams of protein per day based on a & b.
3. [3 points) How many grams of carbohydrate per day should you consume?
Calculate 45-65% of your estimated calories. This is the range you will need to calculate grams of
carbohydrate per day. *Note, use the total calories calculated in question 1"
b How many calories per gram are offered from carbohydrates?
Calculate total grams of carbohydrate per day based on a & b.
4
[3 points) How many grams of fat per day should you consume?
Calculate 20-35% of your estimated calories. This is the range you will need to calculate grams of fat per
Focus
00)
а.
С.
a
day. *Note use the total calories calculated in question 1
247 PM
11/11/2017
g?
113
a
D

Answers

There’s no basic main part but on the questions to do all of them are not able bc of not knowing what it’s on. -4. 520

The final principle of PRICE is ____________________. This allows gravity to drain the fluid away from the injured site.

Answers

the final principle of P.R.I.C.E is elevation

What are two common symptoms of major depression?
A.
obsessive thoughts and sleeplessness
B.
losing items and misunderstanding words
C.
fatigue and lack of interest in activities
D.
hostility and delusional thinking

Answers

Answer:C.

fatigue and lack of interest in activities

D.

hostility and delusional thinking

Explanation:

Answer:

The answere to this question is C. Fatigue and lack of interest in activities.

Explanation:

These are symptoms of depression.

Depression can take the pleasure or enjoyment out of the things you love. A loss of interest or withdrawal from activities that you once looked forward to — sports, hobbies, or going out with friends — is yet another telltale sign of major depression.

5. How does IDEA define speech and language impairments?

Answers

The Individuals with Disabilities Education Act (IDEA) officially defines speech and language impairments as “a communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment that adversely affects a child's educational performance.”

A doctor prescribes levofloxacin to a patient who is suffering various symptoms of prostatitis. These symptoms are caused by inflammation of the prostate resulting from a bacterial infection. Levofloxacin is an effective drug for treating prostatitis because it is an antibiotic. it is a vasodilator. it is a PDE5 inhibitor. it is an androgen agonist.

Answers

Answer:

Levofloxacin is an effective drug for treating prostatitis because is an antibiotic.

Explanation:

Prostatitis is an inflammation of the prostate —a gland in the male genitourinary system— which may be due to a bacterial infection and should therefore be treated with antibiotics.

The germs that cause prostatitis are common bacteria, with levofloxacin being one of the antibiotic therapies of choice. Levofloxacin is a fluroquinolone-type antibiotic with a broad spectrum of action against Gram-positive and Gram-negative bacteria.

The other options are not correct because levofloxacin:

Is not a vasodilator.Is not a phosphodiesterase-5 (PDE-5) inhibitor, as sildenafil.Is not  an androgen agonist, as Dihydrotestosterone.

Today, nearly 1 out of 4 children and teens in developed countries are
overweight or obese.*
10 points
O True
O False

Answers

Answer: True

Explanation:

Answer:

True

Explanation:

It is true  because i looked it up......

Complete the following sentence.

Anorexia nervosa and ________
are eating disorders in which weight loss occurs.

Answers

Answer:

bulimia

Explanation:

these are the disorders that cause you to have eating disorders in which cause weight loss

Answer:

The answer is bulimia

Explanation:

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