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MED112 CODE/BILL
MED112 CH 10 MEDICAID
| Question | Answer |
|---|---|
| MED112 CH 10 | |
| The ____ program was established under Title XIX of the Social Security Act of 1965 to pay for the healthcare needs of individuals and families with low income and few resources. A. Medicare B. Welfare Reform C. SSI D. Medicaid | D. Medicaid |
| What government program provides people with low incomes and few resources cash assistance? A. SSI B. Medicaid C. Welfare D. TANF | D. TANF |
| Federal guidelines mandate coverage for individuals with low incomes and few resources who are also known as the ________. A. categorically covered B. categorically eligible C. guarantors D. categorically needy | D. categorically needy |
| The Children's Health Insurance Program covers children up to what age? A. Twenty B. Eighteen C. Twenty-one D. Nineteen | D. Nineteen |
| Early and Periodic Screening, Diagnosis, and Treatment provides healthcare benefits to children under age twenty-one who are enrolled in ________. A. Medicare B. CHIP C. Medicaid D. Blue Cross Blue Shield programs | C. Medicaid |
| TWWIIA gives states the option of allowing individuals with disabilities to purchase Medicaid coverage that is necessary to enable them to maintain ________. A. food benefits B. coverage C. insurance D. employment | D. employment |
| What was launched in 2003 as the comprehensive plan to reduce barriers to full community integration for people with disabilities and long-term illnesses? A. New Freedom Initiative B. Ticket to Work and Work Incentives C. Early and Periodic Screening, Diagnosis, and Treatment D. Medicaid | A. New Freedom Initiative |
| According to Spousal Impoverishment legislation, which of the following resources held by both spouses are not considered to be available to the spouse in the medical facility? (MAY BE MORE THAN ONE) A. Home B. Automobile C. Household goods D. Burial funds E. Clothing | A. Home B. Automobile C. Household goods D. Burial funds |
| What federal government legislation offers states the opportunity to develop and implement plans for health insurance coverage for uninsured children? A. TANF B. CHIP C. CMS D. HIPAA | B. CHIP |
| What replaced the AFDC program with Temporary Assistance for Needy Families? A. Spousal Impoverishment Protection B. The Welfare Reform Act C. New Freedom Initiative D. Social Security Income | B. The Welfare Reform Act |
| What program provides healthcare benefits to children under age twenty-one who are enrolled in Medicaid? A. CMS B. TANF C. EPSDT D. CHIP | C. EPSDT |
| Most states provide Medicaid coverage to individuals who are ________ with high medical expenses and low financial resources. A. financially well-off B. financially needy C. medically needy D. developmentally needy | C. medically needy |
| What program expands the availability of healthcare services for workers with disabilities? A. TANF B. TWWIIA C. CHIP D. EPSDT | B. TWWIIA |
| A general income and asset guideline states that information provided on the Medicaid application is checked and verified using other sources of information, including which of the following? (MAY BE MORE THAN ONE) A. Internal Revenue Service B. Earned Social Security income C. Social Security Administration D. State Motor Vehicle Agency E. State Department of Labor | A. Internal Revenue Service C. Social Security Administration D. State Motor Vehicle Agency E. State Department of Labor |
| An example of the New Freedom Initiative uses Medicaid grants for community living to promote the use of at-home and community-based care as an alternative to ________. A. ambulatory facilities B. nursing homes C. rehab centers D. hospitalization | B. nursing homes |
| The concept of the spenddown program is very similar to a(n) ________ except that it resets after the time period specified by the state. A. annual deductible B. co-pay C. coinsurance D. premium | A. annual deductible |
| What legislation limits the amount of a married couple's income and assets that must be used before one of them can become eligible for Medicaid coverage in a long-term care facility? A. New Freedom Initiative B. Federal Spousal Impoverishment C. Ticket to Work and Work Incentives Act of 1999 D. Welfare Reform Act | B. Federal Spousal Impoverishment |
| How often do some states issue Medicaid cards to their subscribers? (MAY BE MORE THAN ONE) A. Once each year B. Every two months C. Every six months D. Twice a month E. Once a month | B. Every two months C. Every six months D. Twice a month E. Once a month |
| Who establishes their own Medicaid eligibility standards; their own type, amount, duration, and scope of services; and their own payments to providers? A. States B. Federal government C. Local government D. Districts | A. States |
| To determine eligibility for TANF assistance at the county level, which of the following questions are asked? (MAY BE MORE THAN ONE) A. Does the individual have a Social Security number and a driver's license? B. What is the gender of the applicant? C. Does the household include at least one child under eighteen? D. Does the individual receive adoptive or foster care assistance? | C. Does the household include at least one child under eighteen? D. Does the individual receive adoptive or foster care assistance? |
| Which of the following would be denied if a Medicaid patient is on restricted status? (MAY BE MORE THAN ONE) A. Obtaining prescriptions from allowed pharmacies B. Seeing a physician whose name is not listed on the patient's ID card C. Seeing a physician whose name is listed on the patient's ID card D. Obtaining prescriptions from any pharmacy | B. Seeing a physician whose name is not listed on the patient's ID card D. Obtaining prescriptions from any pharmacy |
| Under the Deficit Reduction Act, the law allowing states to enact their own ________ Acts, which can bring increased recovery amounts if the act is as strong as the one enacted by the federal government. A. Medicaid Integrity B. Work Incentives C. Welfare Reform D. False Claims | D. False Claims |
| One of the general Medicaid income and asset guidelines states that only a portion of ________ income from Social Security benefits, Supplemental Security Income (SSI), and veterans' benefits and pensions is counted toward income limits. A. net B. earned C. gross D. unearned | D. unearned |
| What state program requires individuals to spend a portion of their income or resources on healthcare until they reach or drop below the income level specified by the state to receive Medicaid benefits? A. Ticket to Work B. Medicaid C. Spenddown D. Welfare | C. Spenddown |
| Medicaid beneficiaries are often referred to as which of the following? (MAY BE MORE THAN ONE) A. Guarantors B. Enrollees C. Recipients D. Subscribers | C. Recipients D. Subscribers |
| Who is responsible for determining Medicaid coverage and coverage limits? A. Each state government B. County government C. Local government D. Federal government | A. Each state government |
| Which of the following services are covered under Medicaid? (MAY BE MORE THAN ONE) A. Laboratory and X-ray services B. Cosmetic procedures C. Home healthcare services for people not eligible for skilled nursing services D. EPSDT services for people under age twenty-one, including physical examinations, immunizations, and certain age-relevant services E. Inpatient and outpatient hospital services F. Nurse midwife services | A. Laboratory and X-ray services D. EPSDT services for people under age twenty-one, including physical examinations, immunizations, and certain age-relevant services E. Inpatient and outpatient hospital services F. Nurse midwife services |
| Which Medicaid category requires that a patient see one specific physician and/or use one specific pharmacy? A. Eligible B. Ineligible C. Restricted status D. Preventive status | C. Restricted status |
| Rules regarding services not covered under Medicaid vary from ________. A. state to state B. patient to patient C. country to country D. city to city | A. state to state |
| The Deficit Reduction Act of 2005 created the ________. A. Children's Health Insurance Program (CHIP) B. Welfare Reform C. Medicaid Integrity Program (MIP) D. Spousal Impoverishment protections | C. Medicaid Integrity Program (MIP) |
| Which of the following plans are offered by Medicaid in most states? (MAY BE MORE THAN ONE) A. Managed care B. Fee-for-service C. Welfare D. Restricted | A. Managed care B. Fee-for-service |
| In the fee-for-service Medicaid plan, who submits the claim to Medicaid and is paid directly by Medicaid? A. Clearinghouse B. Insurance company C. Provider D. Patient | C. Provider |
| Each state sets their Medicaid payment rates subject to federal guidelines established under Title XIX of the ________ Act. A. Work Incentives B. Deficit Reduction C. Social Security D. Welfare Reform | C. Social Security |
| Individuals enrolled in a Medicaid managed care plan must obtain all services and referrals through their ________. A. PCP B. CPT C. HMO D. PMP | A. PCP |
| The federal government provides Medicaid patients with matching funds for which of these more common optional services? (MAY BE MORE THAN ONE) A. Prescription drugs B. Diagnostic services C. Elective surgical procedures D. Home care for all patients E. Vision care | A. Prescription drugs B. Diagnostic services E. Vision care |
| Which of the following services may not be covered by Medicaid? A. Skilled nursing facility services for people age twenty-one and older B. Medically necessary services C. Cosmetic procedures D. Transportation to medical care | C. Cosmetic procedures |
| When providers agree to accept payment from Medicaid as payment in full for services, which of the following are true? (MAY BE MORE THAN ONE) A. The difference must be entered into the billing system as a write-off. B. They may not bill patients for additional amounts. C. The difference must be entered into the billing system in collections. D. They may bill the patients for additional amounts. | A. The difference must be entered into the billing system as a write-off. B. They may not bill patients for additional amounts. |
| When filing a claim with Medicaid, when should you determine whether the patient has other insurance coverage? A. During verification processes B. While the claim is in process C. Before filing a claim D. After filing a claim | C. Before filing a claim |
| Medicaid is known as the payer of ________ because it is always billed after another plan has been billed if other coverage exists. A. charges B. last resort C. priority D. first resort | B. last resort |
| Medicaid clients enrolled in a(n) ________ plan may be treated by the provider of their choice as long as that provider accepts Medicaid. A. fee-for-service B. insurance C. contracted HMO D. managed care | A. fee-for-service |
| What are claims billed to Medicare that are automatically sent to Medicaid called? A. Dual-eligibles B. Rebilled claims C. Medi-Medi claims D. Crossover claims | D. Crossover claims |
| With Medicaid managed care plans, claims are sent to the ________ instead of to the state Medicaid department. A. health maintenance organization B. primary care physician C. managed care organization D. national Medicaid department | C. managed care organization |
| The National Medicaid EDI HIPAA Workgroup advises which of the following organizations about HIPAA compliance issues related to Medicaid? A. CMS B. HHS C. NMEH D. OIG | A. CMS |
| A physician who wishes to provide services to Medicaid recipients must sign a contract with the Department of ________. A. Health and Human Services B. Welfare Services C. Social Services D. Medicare and Medicaid Services | A. Health and Human Services |
| Medicaid claims are submitted to which of the following agencies, depending on the particular state? (MAY BE MORE THAN ONE) A. County welfare agencies B. National welfare agencies C. State Department of Health and Human Services D. Fiscal intermediaries | A. County welfare agencies C. State Department of Health and Human Services D. Fiscal intermediaries |
| Before filing a claim with Medicaid, it is important to determine whether the patient has other ________. A. insurance coverage B. employment C. dependents D. payment methods | A. insurance coverage |
| If the patient has coverage through any other insurance plan, the other plan is billed first and then what is forwarded from the primary payer to Medicaid? A. Insurance card B. Remittance advice C. Liability form D. Explanation of benefits | B. Remittance advice |
| Some individuals, called Medi-Medi beneficiaries or ________, are eligible for both Medicaid and Medicare benefits. A. double-eligibles B. double covered C. dual-eligibles D. dual sanctioned | C. dual-eligibles |
| Because Medicaid is a state-based program, coordination of the requirements for completion of the ________ is handled by a national committee called the National Medicaid EDI HIPAA Workgroup (NMEH). A. ICD-10-CM B. HCFA 1500 C. HIPAA 837P D. CMS-1500 | C. HIPAA 837P |
| Applicants who have high medical bills and whose incomes exceed state limits may be eligible for health care coverage under a state ____ program. A. restricted status B. categorically needy C. medically needy D. TANF | C. medically needy |
| Under the Federal Medicaid Assistance Program, the federal government makes payment directly to A. individuals eligible to receive TANF. B. states. C. individuals who are blind or disabled. D. individuals who are categorically needy. | B. states. |
| Most individuals receiving TANF payments are limited to a __________-year benefit period. A. two B. ten C. seven D. five | D. five |
| Under Medicaid, optional services commonly include A. experimental procedures. B. FQHC services. C. prosthetic devices. D. X-ray services. | C. prosthetic devices |
| People classified as restricted status A. receive a limited set of benefits. B. must see a specific provider for treatment. C. must select a provider within the network. D. receive emergency care only. | B. must see a specific provider for treatment |
| If family planning services are provided to a patient, what data element is affected? A. family planning indicator B. HCPCS codes C. the dollar amount of the charge D. ICD-10 codes | A. family planning indicator |
| If services were provided in an emergency room, what place of service code is reported (Hint: Refer to Appendix A)? A. 23 B. 24I C. 18 D. 24C | A. 23 |
| The Medicaid Alliance for Program Safeguards A. audits state Medicaid payers on a regular basis. B. oversees states’ fraud and abuse efforts. C. is a CMS program that came about as a result of the Welfare Reform Act. D. specifies civil and criminal penalties for fraudulent activities. | B. oversees states’ fraud and abuse efforts |
| The national committee to coordinate Medicaid data elements on health care claims is called A. NMEH. B. EDI. C. NUBC. D. HIPAA. | A. NMEH |
| To provide services to Medicaid recipients, physicians must sign a contract with the A. MIP. B. HHS. C. CMS. D. OIG. | B. HHS |
| Ticket to Work and Work Incentives Improvement Act (TWWIIA) | ∙ Enacted in 1999 ∙ Expands healthcare access for workers with disabilities ∙ Allows disabled individuals to buy Medicaid and keep working |
| New freedom Initiative | ∙ Launched in 2001 ∙ Supports independent community living ∙ Reduces barriers for people with disabilities ∙ Includes aging and disability resource center grants |
| Spousal Impoverishment Protection | ∙ Protects a spouse's income and assets ∙ Applies when one spouse enters long-term care ∙ Excludes certain assets (home, car, household goods, burial funds) |
| Welfare Reform Act | ∙ Created TANF ∙ Tightened Medicaid eligibility ∙ Affected disabled children and immigrants ∙ TANF benefits generally limited to 5 years |
| Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | ∙ Covers Medicaid recipients under age 21 ∙ Provides regular health screenings ∙ Covers services beyond screenings ∙ Covers all Medicaid services needed by children ∙ No fees for services; some families pay premiums |
| Children's Health Insurance Program (CHIP) | ∙ Covers children up to age 19 ∙ For low-income families not eligible for Medicaid ∙ Jointly funded by federal and state governments ∙ Covers uninsured children ∙ Includes preventive, physician, inpatient, and outpatient services |
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