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When is balance billing acceptable as it relates to medicaid?

no

What is the monthly premium for medicaid recipients?

no premium

Are all medicaid programs the same no matter what state they are in?

NO

Are there out of pocket costs associated with individual classified as medically needy?

no if they are medically needy

Do state medicaid programs have maximum payable amounts for each service?

yes

How long should medicaid remittance advice forms be kept by providers?

based on state statue

What is "temporary assistance for needy families"?

makes cash assistance available, for a limited time for children deprived of support because of a parent's absence,death,incapacity, or unemployment. Was known as AFDc

Do medicaid recipients have copays?

no because it depends on the state program

What should be sent with a medicaid secondary claim?

remittance advice from primary payer

TANF

temporary assistance for needy families

RA

"remittance advice"

EPSDT

early & periodic screening. diagnositc, & treatment services

SCHIP

state children's health insurance program

QMB

qualified medicare beneficiaries

SSI

supplemental security income

FMAP

federal medical asistance percentage

AFDC

aid to families with dependent children program

QWDI

qualified working disabled individuals

CMS

centers for medicare & medicaid services

HOW CAN A PAYER VERIFY MEDICAID ELIGIBILITY? (KNOW 3 WAYS) ESSAY QUESTION

1.point of service device(swpies the card thru the reader), 2.computer software, 3.automated voice reponse

WHAT IS MEANT BY PAYER OF LAST RESORT? ESSAY QUESTION

if the patient is covered by another insurance policy, medicaid is the payer of last resort

HOW CAN VERIFICATION BE MADE FOR THE RECEIPT OF MEDICAID SERVICES? ESSAY QUESTION

medicaid receipients are sent a monthly survey letter requesting verification of services paid by the previous month on their behalf.

WHAT IS PRESUMPTIVE ELIGIBILITY? ESSAY QUESTION

under SCHIP , it provides medical assistance to children during presumptive eligibility period for medicaid.

WHEN IS A MOTHER/BABY CLAIM USED? WHY? ESSAY QUESTION

submitted for services provided to a baby under mother's medicaid id number. why because baby does not have a id number

WHAT ARE THE MEDICAID COVERAGE CATEROGIES? (THERE ARE 3 THEM) ESSAY QUESTION

manadatory, optional, preauthorized

WHAT ARE THE FEDERAL ELIGIBITY REQUIREMENTS FOR MEDICAID? ESSAY QUESTION

1.preganant women & resultant newborn children, 2.children & teenagers up to age 18 or 21, 3. aged 65 or older adults, blind or disabled, 4. people who are eligible for medicare & low income 5.welfare

ARE PATIENTS WHO ELIGIBLE FOR MEDICARE AUTOMATICALLY ELIGIBILITY FOR MEDICAID?

no

WHAT IS THE RULE FOR MEDICAID ELIGIBILITY FOR INFANTS BORN TO MOTHERS WITH MEDICAID?

the infant of the medicaid receipient is automatically eligible for the entire first year of life.

WHAT COST ARE ASSOCIATED WITH SLMB'S?

medicare part b premiums

WHAT SERVICES ARE OFFERED TO THE MANDATORY ELIGIBILITY GROUP?

inpatient hospital, ouptaient hosp, physician services...see pg 477 for the rest of the list

WHERE WOULD YOU GET INFO ABOUT THE LOCAL MEDICAID PROGRAM?

local county government that administers the program

WHAT IS COVERED UNDER THE SPOUSAL IMPOVERISHMENT PROTECTION ACT? DEFINE THE ACT?

the act keeps the spouse from having to liquidate or spend down income in order for the other spouse to get medicaid......Covered is community spouse home.

MEDICAID IS ADMINISTERED BY EACH STATE & FEDERALLY _____________?

federally manadated, state administered

WHAT PROGRAMS ARE CONSIDERED PRIMARY TO MEDICAID?

all insurances

HOW LONG DOES SCHIP PROVIDE COVERAGE FOR CHILDREN?

age 19

WHAT IS THE NAME OF THE PROGRAM THAT REPLACED AFDC?

tanf

WHAT TYPE OF GOVERNMENTAL ASSISTANCE PROGRAM IS MEDICAID?

medical services

WHAT HAPPENS WHEN A CLAIM IS PAID INCORRECTLY BY MEDICAID, THE CLAIM IS _________?

the claim is voided

MEDICAID ELGIBILITY SHOULD BE VERIFIED HOW OFTEN?

each visit

HOW IS MEDICAID REIMBURSEMENT INFORMATION SENT TO THE PROVIDER ?

remittance advice

QWDI RECIPIENTS ARE NOT REQUIRED TO PAY WHICH COSTS?

medicare part a premiums

DEFINE SUBROGATION?

the assumption of an obligation for which another party is primarily liable.pg 483

A CORRECTLY PAID CLAIM IS CONSIDERED WHAT TYPE OF CLAIM IN THE MEDICAID SYSTEM?

adjusted claim

NAME THE OPTIONAL SERVICES THAT MAY BE COVERED BY MEDICAID DEPENDING ON THE STATE?

basic medical and health care services, therapies, end of life care. There are more

WHAT ARE THE REQUIREMENTS A MEDICARE BENEFICIARY MUST MEET IN ORDER TO BE ELIGIBLE FOR MEDICAID?

low income, limited resources

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