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AR Chapter 13


medicaid is administered by: state government with partial federal funding - providing assistance to low income individuals and familie
medicaid eligibility certain needy and low income people such as: elderly, blind, disabled, and families with children. only available to US citizens. patients can be eligible one month and not the next.
categorically needy care provided to families, pregnant women, aged, disabled and persons receiving institutional of long term care
medically needy general assistance for medically indigent and low income and low income losing employer health coverage. coinsurance, deductible amount must be met with in the eligible month before they can receive state benefits
EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) program of prevention, early detection, and treatment of welfare children who are younger than 21
blocks on the claim form has the least number of mandatory blocks to be completed on the CMS claim form
medicaid fraud each state has a fraud control unit - it is a federally funded state law enforcement entity, that investigates and prosecutes cases of fraud and other violations
bill medicade when patient has private insurance secondary, always the payer of last resort
able to bill a patient when a waiver of liability signed yes, as long as you have informed the patient and they have signed the wavier
3 programs medicaid offers patients over 65: 1)MQMB (Medicare Qualified Medicare Beneficiaries) 2)SLMBs (Specified Low Income Medicare Beneficiares) 3)QI (Qualifying Individuals)
3 categorically needy groups: 1)families and pregnant women, 2)aged and disabled, 3)institutional or long term care
2 co payment types 1)fixed copay - pay at the time service is provided, and 2) share of cost/spend down - this must copayment must be met each month before medicaid pays
condition for a MCHP (Maternal and Child Health Program) to qualify: 1) cerebral palsy, 2)clubfoot, and 3)cleft lip
who is responsible for the guidelines of medicaid CMS (Centers for Medicare and Medicaid Services)
reciprocity applies when the patient obtains services while out of state in which he or she receives benefits - contact the medicaid intermediary in the home state and complete appropriate form - reimbursement is at the home states rate
what year did congress mandate all states set up a program of assistance 1950
can a physician refuse to treat a medicaid patient yes, may accept or refuse patients, but decision is based on medicaid program and not the patients situation
capitated monies are paid on a monthly basis
fee for service money is reimbursed for every service that is performed
Created by: maxphia32