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Mod 3A UHI Ch. 15

Medicaid

QuestionAnswer
Federally mandated... state administered
Medicaid For individuals with incomes below the fedreal poverty level
Medicaid is jointly funded by... federal and state governments.
Establishes its... own eligibiligy standards
Determines the ... type, amount, duration and scope of services
Administers its own program
State legislature may change... medicaid eligibility requirements during the year.
Classification of individuals Categorically or medically needy and special groups.
TANF Temporary Assistance for Needy Families, July 16 1996; children's program
AFDC replaced by TANF
States that implement a medically needy Medicaid program are required to... include pregnant women through a 60-day postpartum and children under age 18, certain newborns for one year and certain protected blind persons.
QMB Qualified Medicare Beneficiaries-states pay Medicare part A premiums
QWDI Qualified Working Disabled Individuals-states pay Medicare part A premiums
QI Qualifying Individual-states pay Medicare part B
SLMB Specified Low-Income Medicare Beneficiary-states pay Medicare Part B
SCHIP State Children's health Insurance Program-allows states to create or expand existing insurance programs to include a number of uninsured children.
PACE Programs of All-inclusive Care for the Elderly-work to limit out of pocket costs to beneficiary by not applying deductibles, copayments or other cost sharing.
What is not included in a couple's combined resources? home, household goods, automobile, and burial funds.
To receive federal matching funds, states must offer... Inpatient hospital, outpatient hospital, lab, x-ray, nursing facility services, EPSDT, family planning services and supplies.
Medicaid operates as a ... vendor-payment program
Exempt from copayments Emergency services and family planning servies.
FMAP Portion of the Medicaid program paid by the federal government.
Medicaid is always payer of last resort
Dual eligibles Eligible for Medicaid and Medicare
Providers are forbidden by law.. to bill patients for Medicaid-covered benefits (balance billing)
MEVS Medicaid Eligibility Verification System-allows providers to electronically access the state's eligibility file.
Verification of Eligibility methods Point of service, Computer software, Automated Voice Response (Telephone)
Voided Claim One that Medicaid should not have originally paid, and results in a deduction from teh lump-sum payment made to the provider.
Adjusted Claim Has a payment correction, resulting in additional payment to the provider.
Medicaid covered services are payable only... When the service is determined by the provider to be medically necessary; consistent with the patient's symptoms, diagnosis, conditionor injury.
Subrogation Another party is liable.
Optometry Optional but not all states have it.
Presumptive eligibility Medicaid insurance is retro back 3 months for children, breast & cervical cancer treatment for women.
Monthly survey letter Sent to Medicaid recipients for verification of services paid the previous month
First 10 days of life of newborn... Covered under mother's ID number
Community spouse The spouse residing at home while the other is in a nursing home.
Questions regarding Medicaid coverage Direct to county government.
Utilization Review Audit
Infant of a Medicaid recipient is .. automatically eligble for Medicaid for the entire first year of life provided the newborn is continuously living with their mother for that full year.
Preauthorization
Created by: ROSSMIBOA
Popular Insurance sets

 

 



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