Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Chapter 15
| Question | Answer |
|---|---|
| Medicaid eligibility is limited to people who fall into three coverage groups | 1) Medically needy 2) Categorically needy 3) Special groups |
| Medicaid provides | medical and health-related services to individuals and families with low incomes ( indigent) |
| Spousal Impoverishment Protection Legislation of 1989 | prevents married couples from being required to spend down income and other liquid assets before one of partners could be declared eligible for nursing care coverage |
| Medically necessary services | are not provided for the sake of anyone's convenience, regardless of whether it is the doctor or patient |
| TANF | Temporary Assistance to Needy Families |
| States are required to | extend Medicaid eligibility to all children born after 9/30/83 until they are 19 years old |
| TANF makes cash assistance available, for | a limited time, for children deprived of support due to parent's absence, death, incapacity or unemployment |
| TANF was previously known as | AFDC (Aid to families with Dependent Children ) |
| SCHIP | State Children's Health Insurance Plan |
| SCHIP allows states to | create or expand existing insurance programs and provides more federal funds to states for the purpose of expanding Medicaid eligibility to include a greater number of children who are currently uninsured |
| Medi-Cal | is California's equivalent to the Medicaid program |
| Medicaid began in | 1965 |
| Surveillance Utilization Review System | Safeguards against unnecessary or inappropriate use of Medicaid services or excess payments and assesses the quality of those services |
| States are required to | provide Medicaid coverage for people who receive federally assisted income-maintenance payments |
| Preauthorization guidelines | include elective inpatient admission |
| States may require | small deductibles, coinsurance or copayments for certain services performed |
| Services covered by both Medicaid and Medicare? | Medicare pays first and Medicaid pays the difference. Medicaid is ALWAYS the payer of last resort |
| In many cases, Medicaid eligibility will depend on | the patient's monthly income |
| Medicaid is | jointly funded by the state and federal governments |
| Each state administers it's own Medicaid program and the | CMS (Centers for Medicare and Medicaid Services) monitors the programs |
| Categorically needy Medicaid eligibility groups are not | necessarily entitled to nursing facility services for individuals under age 21 |
| The BBA allows | states to provide 12 months of continuous Medicaid coverage (without reevaluation) for eligible children under the age of 19 years old |
| Medicaid operates as | a vendors and fee for service payment system |
| Medicaid-covered services must be recognized as | the prevailing standard and consistent with generally accepted professional medical standards of the provider's peer group |
| Providers receive reimbursement from | Medicaid on a lump sum basis- several claims are paid at on time |
| Retroactive eligibility | is sometimes granted to patients who had high medical expenses before filling for Medicaid |
| Emergency and Family Planning services are | exempt from copayments |
| There is a limit on | the amount that a non-contract provider, physician, or other entity can charge a PACE participant |
| Medicaid PARs ( participating providers) | have to accept the Medicaid payment as payments in full |
| The Medicaid Eligibility Verification System | allows providers to electronically access the state eligibility file |
| States must provide | home health services to beneficiaries who are entitled to receive nursing facility services |
| Federal Medical Assistance Percentage | the portion of the Medicaid program paid by the federal government |
| Dual eligible | refers to individuals entitled to Medicare and eligible for some type of Medicaid services |
| The federal government reimburses states | 100% of the cost of services provided through facilities of the Indian Health Service |
| Spend down to Medicaid eligibility is | used for the medically needy |
| EPSDT | routine pediatric checkups for all children enrolled in Medicaid |
| Mother/baby claim refers to | services provided to a baby under the mother's ID number |
| PACE | alternative care for people 55 or older who require nursing facility level care |
| Community Spouse | spouse who is not in nursing home |
| Voided claim | a deduction is taken from the lumps-sum payment made to provider |
| Medicaid Remittance Advice | Shows the current status of all claims |
| MCCA | prevents married couples from being required to spend down |
Created by:
drea08
Popular Medical sets