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40 terms

Medical Billing Worksheet Chapter 15-Medicaid

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PLAY
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