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MIBC F12

A Fordney Ch 12

QuestionAnswer
TEFRA stands for Tax Equity and Financial Reimbursement Act False
The federal government designs the Medicaid program for each state based on the needs of the state False
Medicaid is not so much an insurance program as an assistance program True
Medicaid is an established program of medical assistance in 46 states False
Medicaid is administered by federal funding only False
The federal government determines the payment for medical services in the Medicaid program False
Emergency care and pregnancy services are exempt by law from copayment requirements True
The medicaid patient may be responsible for a copayment True
The federal government financially supports the minimum assistance level of the medically needy aged, and the states must wholly support any part of the program that goes beyond the federal minimum True
It is possible for a Medicaid patient to be on Medicaid 1 month and off Medicaid the following month True
A physician may accept or refuse Medicaid patients on the basis of the individual patient and his or her circumstances False
If a patient's Medicaid eligibility is checked when the patient is seen on February 1, the patient's eligibility need not be checked again if the patient is seen on February 28 True
In some cases, the welfare office may grant retroactive eligibility to a patient True
Family planning is a Medicaid basic benefit True
Home health care is never covered under Medicaid False
If a service is totally disallowed by Medicaid, a physician is within legal rights to bill the patient True
All states Medicaid programs operate with a fee-for-service reimbursement system False
Medicaid patients in managed care plans must go to hospitals participating in their assigned plan True
The gatekeeper in a Medicaid managed care program is the specialist to whom the patient is referred False
Managed care Medicaid programs usually save money in health care delivery True
Prior approval or authorization is never required in the Medicaid program False
All states that do not optically scan their claim forms must bill using the CMS-1500 claim form True
When Medicaid and a third-party payer cover the patient, Medicaid is always the payer of last resort. True
It is not possible for an alien to have Medicaid coverage False
It is not possible for a person to be eligible for Medicaid benefits and also have additional group health insurance coverage False
The Social Security Act of 1935 set up the public assistance programs True
The Federal Emergency Relief Administration does not make funds available to pay for medical expenses of the needy unemployed False
The Medicaid program was a direct result of a law passed by Congress in 1950 True
In the Medicaid program, Congress authorized vendor payments for medical care, which are payments from the welfare agency directly to the physician True
The medically needy aged do not require help in meeting costs of medical care False
DEFRA and CHAP were responsible for expanding Medicaid eligibility requirements True
Medicaid is administered by the state government with partial federal funding True
The federal aspects of Medicaid are the responsibility of CMS
The Omnibus Reconciliation Act Provided assistance for the aged and disabled who are receiving Medicare and whose incomes are below the poverty level
Medicaid is available to needy and low-income people such as The disabled, the blind and those age 65 years or older
Basic Maternal and Child Health Program (MCHP) provisions offered in all states include Children with handicap needs who require orthopedic treatment or plastic surgery
If a physician accepts Medicaid patients, the physician must accept The Medicaid-allowed amount
Medicaid eligibility must always be checked for the Month of service and the type of service
The Medicaid service for prevention, early detection, and treatment for welfare children is known as EPSDT
To control escalating health care costs by curbing unnecessary emergency department visits and emphasizing preventive care, Medicaid reform has involved Managed care programs
Medicaid managed care patient claims should be sent to the Managed care organization and not the medicaid fiscal agent
The time limit to appeal a claim varies from state to state, but it is usually 30 to 60 days
The abbreviation for the Deficit Reduction Act of 1984 is DEFRA
Medicaid was legally established by Title XIX
The group of Medicaid recipients referred to as categorically needy includes all cash recipients of the Aid to Families with Dependant Children, certain other AFDC-related groups, most cash recipients of the Supplemental Security Income program, and other SSI-relate groups
The two Medicaid eligibility classifications are categorically needy group and the medically needy class
Some medicaid recipients in the medically needy category must pay a coinsurance payment and/or deductible, also known as a/an share of cost within the eligibility month before state benefits may be received.
Medicaid identification cards are usually issued every month
Time limits for Medicaid claim submission can vary from _ from the date of service depending on the state in which service was provided two months to 1 year
Most states have __ for Medicaid payments if a patient requires medical care while out of state reciprocity
The __ form, formerly known as an explanation of benefits form, accompanies all Medicaid payment checks remitance advice
Created by: leemiller on 2005-11-06



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