Question | Answer |
The federal government is in control of each State's medicaid program. | FALSE. The Feds have general guidelines to follow. The State controls the details of the program. |
Medicaid is funded by the federal government only. | FALSE. Both Sate and Federal funds contribute. |
The patient's medicaid card needs to be checked at each office visit. | TRUE. A patient can be on Medicaid one month and off Medicaid
. |
Medicaid benefits of the same from state to state. | Medicaid benefits very from state to state they are not identical. |
Reciprocity allows one state to accept the charges of Medicaid from another state. | This is true, however, reciprocity is usually allowed only for states that are next to each other (contiguous). |
If a patient is covered by Medicaid and another health insurance plan, Medicaid will pay… | Last. |
What is a TAR | Authorization from Medicaid which allows a procedure to be performed or allows equipment to be prescribed. |
Balance billing is allowed and Medicaid | Balance billing is not allowed in Medicaid, Medicare, and most managed-care plans. |
All states processing medical claims must build using which claim form? | CMS 1500 |
EPS DT is supported and encouraged by Medicaid for… | Pregnant women and children. |
Assignment should be accepted at all Medicaid claims if… | The doctor wants to be paid |
The category "medically needy" means… | The family makes too much gross income to qualify for Medicaid. However, due to medical expenses they have had, they can only afford insurance through Medicaid. |
"Categorically needy" are those who... | Have a low income and do qualify for medicaid. |
Who is Medicaid available to: | The blind, the disabled, the aged (65 years or older), pregnant women and children |
On the CMS claim form, the doctor will check "accept assignment". This means that the doctor will accept… | The fee amount approved by Medicaid as the complete payment. |
Aged and disabled persons who are very poor are covered under both the Medicaid and Medicare programs. These individuals are referred to as… | Dual eligibles, or Medi-Medi. |
Medical necessity is… | Appropriate treatment ort care for a particular diagnosis which was arrived at using standard accepted medical diagnostic testing. |
The Medicaid patient may be responsible for some copayment as a "cost sharing" fee. | TRUE. Medicaid may have copayments required in order to help fund the program. |
The FPL is… | The federal pover line. Individuals below this number can qualify for Medicaid. |
When does making more than the FPL allow a person to qualify for Medicaid? | (1) Obama care now accepts those over the FPL by 13 percent. (2) those who are categorically "medically needy". |
Medicaid was established by… | Congress under title XIX of the Social Security act. |
providesThe SSI program provides cash assistance to… | The elderly and disabled poor. |
Medicaid is administered by... | CMS under the direction of the Department of Health and Human Services (HHS). |
QMBs are... | MedicareQualified Medicare beneficiary. This is an individual that is receiving Medicare but also qualifies for Medicaid. |
Federal standards dictate that categorically needy individuals must be provided with | |
EPSDT stands for… | Early periodic screening and diagnosis |
The SCHIP is... | State Children's Health Insurance program. This allows States to expand the categories of children covered. |
Doctors can decide if they wish to treat Medicaid patients. | This is true; each state has its own rulings. |