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Insurance Chapter 13
Chapter 13 Insurance
| Question | Answer |
|---|---|
| What is Medicaid? | A federal-state entitlement program for low-income Americans that covers basic health and long-term care services. |
| What does Medicaid cover? | Basic health and long-term care services. |
| Who administers Medicaid? | The States within Federal guidelines |
| Who gets Medicaid? | Low-income Parents and children Low-income Elderly Low-income Disabled Low-income Blind |
| What percent of national spending is Medicaid? | 16% |
| Of the 16% of national spending on Medicaid what percent goes toward long-term care services? | 41% |
| Medicaid provides health insurance to how many children? | 29 million |
| Medicaid provides health insurance to how many low income adults? | 15 million |
| Medicaid provides health insurance to how many elderly and persons with disabilities? | 14 million |
| What percent of Medicaid beneficiaries are duel eligible? | 19% |
| What % of all federal funds go to states cover medicaid? | 45% |
| What population is effected the most as a percent of that population by medicaid? | Nursing Home Residents 70% |
| What is the impact on medicaid due to rising rates of unemployment? | Increased Medicaid enrollment by 2.8 million and increased total uninsured by 3.0 million. |
| What does medicaid cover? | Mandatory services, optional services, and services must be adequate in amount, duration, and scope |
| What are examples of the mandatory services covered by medicaid? | Inpatient & outpatient hospital Lab and X-ray Nursing facilities Physician Services Transportation Emergency Dental Services |
| What are examples of optional services covered by medicaid in most states? | Pharmacy services Community Long-term Care Hospice Preventive Screenings Durable Medical Equipment Physical Therapy Chiropractic Services Case Management Click to flip |
| What are the requirements for medicaid? | Services must be offered throughout the state. States may not vary the amount, duration, or scope of a covered service because of a recipient's diagnosis or condition. States may impose copayments on some services for some groups of recipients. |
| Who Pays for Medicaid? | Federal and State governments |
| Is state participation required or optional? | Optional |
| What percent on average does the federal government pay of the costs of the Medicaid program based on the state's per capita income? | 57% |
| What is the largest single source of Federal funds to the states? | Medicaid |
| ____ of all medicaid spending is for populations and services that are optional for the states. | 2/3rds |
| Does medicaid or medicare cover more Americans? | Medicaid |
| What percent of Georgians are covered by Medicaid? | 17% |
| What percent of South Carolinians are covered by Medicaid? | 20% |
| Medicaid is the US's largest single purchaser of _______ care and _________ care. | Maternity and long-term |
| Medicaid accounts for ____ of all spending on nursing homes. | 33% |
| Medicaid accounts for ____ of all spending on Hospital care. | 18% |
| What is medicaid's impact in GA? | Covers 1 out of every 5 people Pays for 1 out of every 2 births Pays for 70% of all nursing home beds |
| What is medicaid's impact in SC? | Covers 1 out of every 5 people Covers 2 out of every 5 children Covers 1 out of every 3 elderly Pays for 1 of every 2 births Pays for 75% of all nursing home beds |
| What population does medicaid payout the most in expenditures to? | Disabled |
| What percent of expenditures of Medicaid go to disabled persons? | 42% |
| What takes up more of the medicaid expenditures acute care or long-term care? | Acute Care |
| What percent does acute care account for of the total medicaid expenditures? | 61.9% |
| What percent does long-term care account for of the total medicaid expenditures? | 33.3% |
| What does SCHIP stand for? | State Children Health Insurance Program |
| What does SCHIP do? | Provides insurance for uninsured children not eligible for Medicaid. |
| How do states set up a SCHIP program? | Expanding their Medicaid program Designing a separate program Implementing a combination of the two |
| Medicaid is administered by _______ with partial ____ funding | state government; federal |
| Medicaid is not an insurance program. It is a ________ program | assistance |
| In all other states, the program is known as Medicaid, but in California the program is called _________ | Medi-Cal |
| Because the federal government sets minimum requirements, states are free to enhance the Medicaid program. Name two ways in which Medicaid programs vary from state to state | coverage, and benefits |
| SCHIP means ___________ and MCHP means _____________ and covers children of what age group? | State Childrens health insurance program; maternal and child health programs; younger than 21 years |
| name three aid programs for low-income Medicare patients | Medicaid qualified Medicare beneficiary programs; specified low-income medicare beneficiary program; qualifing individuals program |
| name two broad classifications of people eligible for Medicaid assistance | categorically needy; medically needy |
| the name of the program for the prevention, early detection, and treatment of conditions of children receiving welfare is known as ________________. it is abbreviated as _______ | early and periodic screening, diagnosis and treatment; EPSDT |
| your medicaid patient seen today needs long term hemodialysis services. you telephone for authorization to get verbal approval. Four important to obtain are: | date of authorization; name of the person who provided authorization; approximately time of day authorized was given; verbal number given by field office |
| the time limit for submitting a medicaid claim varies from _________ to _________ from the date the service is rendered. | 2 months; 1 year |
| the insurance claim form for submitting medicaid claims in all states is | CMS-1500 health insurance form |
| you Medicaid patient also has TRICARE. what billing procedure do you follow? be exact in your steps for a dependent of an active military person | bill TRICARE first; Bill Medicaid second and attach remittance advice |
| five categories of adjudicated claims that may appear on a Medicaid remittance advice documnet are: | adjustments, approvals, denials, susends, audit/refund transactions |
| name three levels of medicaid appeals | regional fiscal intermediary or medicaid bureau, dept of social welfare or human services, appellate court |
| when professional services are rendered the medicaid identification card or electronic verification must show eligibility for | Month of service |
| when a Medicaid patient is injured in an automobile accident and the car has liability insurance, this involves a third party payer so the insurance claim is sent to the | automobile insurance carrier |
| the only state without a medicaid program that is similar to those existing in other states that has analternative prepaid medical assistance program isq | Arizona |
| a patients medicaid eligibility may be verified by | touch tone telephone, modem, special Medicaid terminal equipment |
| when a medicaid patient requires a piece of durable medical equipment, the physician must | obtain prior authorization, preferably written |
| medicaid beneficiaries who are disabled but have annual incomes below the federal poverty level may be eligible for | medicaid qualified medicare beneficiary program, qualifying individuals program, specified low-income medicaire beneficiaries program |
| cerebral palsy is a condition that qualifies a child for benefits under the maternal and child health program | true |
| there is only one type of copayment requirement in the Medicaid program | False |
| when filing a claim for a medicaid managed care patient, transmit the claim to the managed care organization and not the medicaid fidcal agent | true |
| providers must enroll for participation in the medicaid program with the fiscal agent for their region | true |
| a state agency that investigates complaints of mistreatment in long term care facilities is the medicaid fraud control unit (MFCU) | true |
Created by:
Lea99