Ch. 13 Insurance Bk

25 terms by dororo4510

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Medicaid id administered by _______________ with a partial__________ fundings.

a. state governments
b. federal

Medicaid is not an insurance program. It is a/an _____________ program.

assistance

In all other states, the program is known as Medicaid, but in California the program is called ____________.

Medi-cal

Because the federal governement sets minumum requirements states are free to enhance the Medicaid program. Name two ways in which Medicaid programs vary from state to state.

a. coverage
b. benefits

SCHIP means ______________________ and MCHP means ___________________ and covers children of what age group? __________

a. State Childrens' Health Insurance Program
b. Maternal and Child Health Program.
c. Younger than 21

Name the three aid programs for low-income Medicare patients.

a. Mediaid Qualified Medicare Beneficiary Program
b. Specified Low-Income Medicare Beneficiary Program
c. Qualifiying Individuals Program

Name two broad classifications of people eligible for Medicaid assistance.

category needy & Medicaly needy

The name of the program for the prevention, early detection, and treatment of conditions of children receiving welfare is known as _____________________. It is abbreviated as ________.

a. Early and Periodic Screening, Diagnosis, and Treatment.
b. EPSDT

Your Medicais patient seen today needs long-term hemodialysis services. You telephone for authorization to get verbal approval. Four important items to obtain are:

a. date of authorization
b. name of the person who provided authorization
c. approximate time of day authorization was given
d. verbal number given by field office

The time limit for submitting a Medicaid claim varies from _______ to _______ from the date the service is rendered. In your state, the limit is ________.

a. 2 months to 1 year
b. 6 months

The insurance claim form for submitting Medicaid claims in all states is __________________.

CMS 1500 Insurance Claim Form.

Your Medicaid patient also has TRICARE. What billing procedure do you follow? Be exact in your steps for a dependent of an active military person.

a. Bill TRICARE first
b. Bill Medicaid second and attach a Remittance Advice, Explanation of Benefits, or check voucher from TRICARE to the billing form.

Five categories of adjudicated claims that may appear on a Medicaid remittance advice document are:

a. Adjustments
b. Approvals
c. Denials
d. Suspends
e. Audit/refund

Name three levels of Medicaid appeals.

a. Regional fiscal intermediary or Medicaid bureau
b. Depratment of Social Welfare or Human Services
c. Appellate court

When professional services are rendered, the Medicaid isdentitfication card or electronic verification must show eligibility for ___

c. month of service.

When a meicaid patient is injured in an automobile accident and the care has liability insurance, this involves a third-party payer so the insurance claim is to the ___

b. the automobile insurance carrier.

The only state without a Medicaid program that is similar to those existing in other states that has alternatives prepaid medical assitance program is ___

a. Arizona.

A patient's Medicaid eligibility may be verified by ___

a. touch-tone telephone.
b. modem.
c. special Medicaid terminal equipment.

When a Medicaid patient requires a piece of durable medical equipment, the physician must __

b. obtain prior authorization, preferably written.

Medicare beneficiaries who are disabled but have annual incomes below the federal poverty level may be eligibile for ___

a. Medicaid Qualified Medicare Beneficiary Program.
b. Qualifying Individuals Program.
c. Specified Low-Income Medicare Beneficiary Program.

True or False: Cerebral palsy is a condition that qualifies a child for benefits under the Maternal and Child Health Program.

True

True or False: There is onlt one type of copayment requirement in the Medicaid program.

False

True or False: When filling a claim for a Medicaid managed care patient, transmit the claim to the managed care organization and not the Medicaid fiscal agent.

True

True or false: Providers must enroll for participation in the Medcaid program with the fiscal agent for their region.

True

True or False: Astate agency that investigates complaints of mistreatment in long-term care facilities is the Medicaid Fraud Control Unit (MFCU)

True

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