Medical Billing Worksheet Chapter 15-Medicaid

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Name the equivalent of the Medicaid program that is offered in the State of California

Medi-Cal

Cash assistance for children deprived of support

TANF (Temporary Assistance for Needy Families)

What year was the Medicaid program implemented?

1965

The federal government reimburses states for ----of the cost of services provided through facilities of the Indian Health Service.

100%

Categorically needy, Medically needy, and -----are all covered under Medicaid.

Special Group

------Eligibility is sometimes granted to patients who had high medical expenses

Retroactive

This is the age requires states to extend Medicaid eligibility to all children born after September 30, 1983

19

Routine pediatric checkups for all children enrolled in Medicaid

ESPDT (Early and Periodic Screening, Diagnostic, and Treatment services)

----- provides medical and health-related services to individuals and families with low incomes

Medicaid

These Guidelines include elective inpatient admission

Preauthorization

Previously known as the organization that gives aid to Families with Dependent Children

TANF

When charging a ----- participant there is a limit on the amount that a noncontract provider, physician, or other entity can charge a PACE participant

PACE

Medicaid is jointly funded by the ---- and state governments to assist states in providing adequate medical care to qualified individuals

Federal

Federal Medical Assistance percentage applies to a portion of Medicaid ---- paid by the federal government

Program

Spend down to Medicaid eligibility applies to the -----

Medically Needy

------- Medicaid eligibility groups are not necessarily entitled to nursing facility services for individuals under the age

Categorically needy

States are required to provide Medicaid --- for individuals who receive federally assisted income-maintenance payments.

coverage

The --- allows states to provide 12 months of continuous Medicaid coverage (without reevaluation) for eligible children under the age of 19

BBA

States can require nominal----- , coinsurance, or copayments for certain services performed

deductibles

Medicaid operates as a vendor and ------payment system

Fee-For-Service

-----eligibles refers to individuals entitled to Medicare and eligible for some type of Medicaid services

Dual

The federal government reimburses states for ----- of the cost of services provided through facilities of the Indian Health Service

100%

States must provide home health services to ---- who are entitled to receive nursing facility services.

Beneficiaries

Medicaid------services must be recognized as the prevailing standard and consistent with generally accepted professional medical standards of the providers' peer group

covered

----services are not provided for the convenience of the recipient or provider

Medically Nessessary

Claims should be ----- when the payment on the remittance advice does not match the claims submitted.

Appealed

Required for certain Medicaid procedures

preauthorization

Temporary Assistance for Needy Families

TANF

State children's health insurance program

SCHIP

providers can electronically access the state's eligibility

eligibility verification

individual entitled to Medicare and Medicaid

dual eligibility

Depends on patients monthly income

Medicaid eligibility

prevents married couples from being required to spend down

MCCA (medicare catastrophic act of 1988)

Alternative care for persons aged 55 or older in nursing facilities

PACE

Safeguards against inappropriate use of Medicaid Services

Surveillance and utilization review system

Providers receive reimbursement from Medicaid on a ---- or several claims at once

Lump sum basis

The portion of the Medicaid program paid by the federal government

Federal Medicaid Assistance Program

Emergency and ----- services are exempt from copayments from Medicaid recipients

Family planning

Any provider who accepts a Medicaid patient must accept the Medicaid determined payment as-----

Lump sum

Spouse who is not in a nursing home

community spouse

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