SOLVED

61. Allowing a sibling to be seen under a brother or sister’s name so that the visit will be covered by insurance is considered: a.ethical because the siblings have the same parents. b.fraud. c.questionable but not fraudulent. d.unethical but not illegal. 62. When a medical biller changes a diagnosis in the medical record so that it matches the procedure code on a health claim, the biller can be charged with: a.inappropriate coding. b.abuse of power. c.abuse of knowledge. d.fraud. 63. Which of the following is considered insurance fraud? a.Billing patients at different rates b.Submitting bills to more than one insurance provider without notifying any of them about the duplication c.Billing Medicare for a worker’s compensation injury d.All of the above 64. What practice can help track down the person submitting fraudulent claims? a.Having the initial claims that medical billers create and/or submit b.Copying all the claims and having a second party review them for accuracy c.Having the physician review all claims prior to submission d.Using only a few set of codes to prevent mistakes 65. If a provider or biller is found guilty of Medicare fraud, what is the consequence? a.Imprisonment b.Fines c.Permanent removal from working with the Medicare program d.Loss of professional license 66. When physicians accept Medicare assignment, it means they agree to: a.only see Medicare patients. b.only bill Medicare insurance. c.accept the Medicare billing rules. d.charge every patient the Medicare rate. 67. If a practice violates a Medicare billing rule, the claim may be: a.sent back to the provider for revision. b.sent to a Medicare review contractor. c.denied. d.All of the above 68. Under Medicare rules, kickbacks include which of the following? a.Double billing for services b.Writing off a portion of the bill that is the patient’s responsibility c.Accepting a Christmas card from suppliers d.None of the above 69. When Medicare contacts you and puts a written warning in the providers file, it is called: a.suspension or dismissal from the Medicare program. b.educational contact or warning. c.recoupment of overpayments. d.criminal prosecution. 70. When a letter is sent by Medicare stating that funds are owed due to overpayment, it is called: a.suspension or dismissal from the Medicare program. b.educational contact or warning. c.recoupment of overpayments. d.criminal prosecution.