Title XIX of the Social Security Act of 1965 established:
Medicaid is administered by:
The Social Security Administration
Supplemental Security Income (SSI) is a cash benefit program controlled by:
Low-income families with children, Individuals receiving SSI, Pregnant women, infants, and children with incomes less than a specified percent of the federal poverty level (FPL), Qualified Medicare Beneficiaries (QMBs)
Categorically needy individuals typically include:
The term used for the process of depleting private or family finances to the point where the individual/family becomes eligible for Medicaid assistance is:
Program of All-Inclusive Care for the Elderly
The program that provides comprehensive alternative care for noninstitutional elderly who otherwise would be in a nursing home is known as:
no less than once a month
Medicaid coverage should be verified:
Dual eligibles, Medi-Medi, Supplemental coverage
Aged or disabled individuals who are very poor are covered under the Medicaid and Medicare programs, which are commonly referred to as:
Medicare beneficiaries who qualify for certain Medicaid benefits if they have incomes below the FPL and resources at or below twice the standard allowed under the SSI program are known as:
When one state allows Medicaid beneficiaries from other states to be treated in its medical facilites, this exchange of privileges is referred to as:
Medicaid benefits are the same from state to state.
All states have a Medicaid program.
In 1972, federal law established the SSI program, which provides federally funded cash assistance to unmarried pregnant women with dependent children.
To be eligible for SSI, an individual must be at least 65 years old, blind, or disabled, and have limited resources.
Eligibility for SSI benefits is based on an individual's employment record.
All states must cover the cost of prescription drugs for all categories of Medicaid recipients.
All providers must accept and treat all categories of Medicaid parties.
Providers must agree to accept what Medicaid pays as payment in full for covered services and are prohibited by law to "balance bill."
Medicaid, by law, is intended to be the "payer of last resort."
The time limit for filing Medicaid claims in all states is 1 year.
Providers are never allowed to ask a Medicaid-eligible patient to make a copayment.
Assignment should be accepted on all Medicaid claims.
People older than 65, People with end-stage renal disease, People younger than 65 with disability.
Medicare was established by Congress in 1996 to provide financial assistance with medical expenses to :
Medicare requires its beneficiaries to pay premiums, deductibles, and coinsurance, which is referred to as:
Taxes withheld from employees' wages, Taxes paid by employers
Medicare Part A, the hospital insurance part of Medicare, is funded through:
Coverage requirements under Medicare state that for a service to be covered, in must be considered:
are eligible to receive Social Security benefits
Part A coverage is available free of charge to eligible Medicare beneficiaries who:
fiscal intermediary (FI)
A private organization that contracts with Medicare to pay Part A and some Part B bills and determine payment to Part A facilities is called a:
Medically necessary physician's services
Medicare Part B helps pay for:
Medicare pays ________ % of allowable charges after the annual deductible is met.
The __________________ is the duration of time during which a Medicare beneficiary is eligible for Part A benefits for services incurred in a hospital or skilled nursing facility (SNF) or both.
Medicare Part C
Managed Healthcare plans that offer regular Part A and Part B Medicare coverage and additional coverage for certain other services are called:
Medicare Part D
The prescription drug coverage plan, which began in January 2006, is called:
The period during which a Medicare beneficiary is responsible for all prescription drug expenses until a total of $3850 (2007 figure) is spent out-of-pocket is referred to as the:
An individual qualifying for Medicare and Medicaid benefits is referred to as a:
The program that provides community-based acute and long-term care services to Medicare beneficiaries is called:
A health insurance plan sold by private insurance companies to help pay for healthcare expenses not covered by Medicare is called a:
Medicare Secondary Payer(MSP)
The term used when another insurance policy is primary to Medicare is:
Some Medicare health maintenance organization (HMO) enrollees are allowed to see specialists outside the "network" without going through a primary care physician. This is called:
provider sponsored organization
A group of medical providers that skip the insurance company middleman and contracts directly with patients is referred to as a:
Local medical review policies (LMRPs) were replaced in 2003 by:
A form that Medicare requires all healthcare providers to use when Medicare does not pay for a service is the:
Medicare Parts A and B are provided free of charge for qualifying individuals.
Part A covers custodial and long-term care.
Neither Medicare Part A nor Part B covers any preventive care services.
For durable medical equipment to qualify for Medicare payment, it must be ordered by a physician for use in the home, and items must be reuseable.
Most Medicare Part B beneficiaries pay for Part B coverage in the form of a premium deducted from their monthly Social Security check.
Medicare beneficiaries are allowed only one "benefit period" per year.
An individual must be eligible for Part A or B to enroll in a Medicare Advantage Plan.
If a beneficiary has a Medicare Advantage Plan, he or she still needs a supplemental policy.
The private organization that determines payment of Part B covered items and services is called a peer review organization.
If individuals do not sign up for Medicare Part B when first becoming eligible and later decide to enroll, the monthly premium may be higher because of penalties.
When an individual turns 65 and enrolls in Medicare, federal law forbids insurance companies from denying eligibility for Medigap policies for 6 months.
Workers' compensation would likely be a primary payer to Medicare.
Medicare HMOs typically screen potential enrollees for preexisting conditions.
Under certain circumstances, a signed release of information form for Medicare beneficiaries can be valid for more than 1 year.
Medicare's definition of medical necessity must specific criteria.
Medicare health insurance claim numbers are typically in the format of nine numeric characters followed by one alpha character.
The Medicare fee schedule is now based on a resource-based relative value system.
Medicare nonPARs do not have to submit claims for their Medicare patients.
The process of matching one set of data elements or category of codes to their equivalents within a new set of elements or codes is called a crossover.