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# BAS 03 Medicaid

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.
Created by: rjmtoss
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