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MEDICAID JACKSON
| Question | Answer |
|---|---|
| adjusted claim | claim where the amount paid has been corrected |
| balance billing | when provider attempts to bill patient the write off |
| community spouse | spouse that lives at home while other is in nursing home suffering |
| dual eligible | receives benefits from medicare and medicaid |
| mother baby claim | used for babys first ten days of life while babys medicaid application is being processed |
| payer of last resort | medicaid is paid last, after every other insurace company, bacuse medicaid had like mo money, at all |
| presumptive eligibilty | allows individuals to be enrolled in medicaid for limited time before full application is filed and processed |
| QMB | resources at below twice SSI standard and +100% of federal proverty level |
| QWDI | recipients do not pay medicare part a permiums |
| remittance advice | details medicaid's reimbursement on claim. law set by state. attached to medicaid claim after otehr insurance is billed |
| SCHIP | covers children up to 19 |
| SLMB | recipients do not pay medicare part b peremiums |
| TANF | provides cash assistance for children whose parents are unable to care for them |
| utilization survey | sent to medicaid patients to verity services received in month prior |
| voided claim | claim that medicaid should not have paid |
| EPSDT | early periodic screening diagnostic treatment |
| FMAP | federal medical assistance percentage |
| QI | qualified individual |
| QMB | qulified medicare beneficiary |
| SCHIP | state children health insurance program |
| SLMB | specified low income medicare beneficiary |
| SSI | supplemental security income |
| TANF | temporary assistance for need families |
| medicaid may have to pay | copay, co-insurance, deductible, or permium |
| establishes the max payable amount for each medicare service | state |
| medicaid covers | medical services |
| optometrist | optional service |
| family planning services and supplies | mandatory service |
| verify eligibility of patient's medicaid | every visit |
| any questions about medicaid should be addressed to the | local county government |
| a baby born to medicaid eligible mother receives coverage for | one year |
| medicaid is not free for just anyone who is | medically needy. (must be blow federal proverty level) |
| medicaid if different from | state to state (different state administer things differently) |
| 8 federal requirements for medicaid | TANF |
| 8 federal requirements for medicaid | pregnant + below federal poverty level |
| 8 federal requirements for medicaid | caretakers/children below fpl |
| 8 federal requirements for medicaid | SSI recipient |
| 8 federal requirements for medicaid | medically needy + below fpl |
| 8 federal requirements for medicaid | special groups |
| 8 federal requirements for medicaid | foster family |
| 8 federal requirements for medicaid | instiutionalized individuals |
| medicare coverage categories | mandatory |
| medicare coverage categories | optional |
| medicare coverage categories | preauthorized |
| ways to verify medicaid eligibility | telephone |
| ways to verify medicaid eligibility | internet |
| ways to verify medicaid eligibility | point of service (card swiper) |
| subrogation | assuming an obligation when another party is liable |
Created by:
quece79
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