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45 terms

Medicade Test

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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