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UHI Medicaid
| Question | Answer |
|---|---|
| TANF | Temporary Assistance for Needy Families |
| TANF was formally known as | AFDC (aid to families & dependent children) |
| EPSDT | Early & Periodic Screening Diagnostic & Treatment |
| SCHIP | State Children's Health Insurance Program |
| OMB | Qualified Medicare Beneficiaries |
| SSI | Supplemental Security Income |
| FMAP | Federal Medical Assistance Percentage |
| What is the differecne between Medicaid and TNAF? | TNAF is food and cash assistance, Medicaid is Medical insurance |
| When do Medicaid patients pay out of pocket? | Non covered monthly insurance premiums, out of pocket expenses, deductiable & copays |
| What is a Community Spouse? | the spouse of a nursing home patient left at home |
| What is Medi-Medi | duel elibible, patient has both Medicare and Medicaid. |
| How is eligibility determined for Medicaid at the provider's office? | MEV (Medicaid eligibility Verification) |
| What are the 3 types of MEV? | point of sale, computer software, automated voice response |
| When do you verify the patient's Medicaid eligibility? | Each time they receive services |
| When must hospitalizations be preauthorized? | when they are non emergency |
| Who receives the payment the patient or provider? | provider |
| Medicaid what implemented in what year | 1965 |
| Medicaid is jointly funded by whom? | federal & the state |
| What are the three groups covered under Medicaid? | Categorically needy, Medically needy & Special groups |
| Categorically needy medicaid eligibility groups are not nescessarily entitled to | nursing facility services for inividuals under the age of 21 |
| medicaid operates as an what type of payment system? | Vendor & fee for service |
| What types of services are exempt from copayments from Medicaid recipients? | Emercency & Family planning |
| The portion of Medicaid program paid by the federal government is known as the | Federal Medical Assistance Percentage |
| Medicaid is always either the what payer? | secondary payer or payer of the last resort |
| Any provider who accepts a Medicaid patient must accept the Medicaid-determined payment as | payment in full |
| How do providers received reimbursement form Medicaid? | Lump sum, several claims at once, Medicaid Remittance Advice |
| Medically needy | spend down on Medicaid eligibility |
| Safeguards agains inappropriae use of Medicaid services | Surveillance and utilization review system |
| PACE | Alternative care for persons aged 55 or older who require nursing facility level care |
| MCCA | prevents married couples from being required to spend down |
| Deduction from lump-sum payment made to provider | voided claim |
| adjustment in the lump-sum payment made to provider due to elegilibity of the patient | adjusted claim |
| Services provided to a baby under mother's ID number | Mother/baby claim |
| who is eligable | families with incomes at or below the federal poverty level, until they reach 19 years old |
| who do you contact for Medicaid laws and or questions (Fiscal Agent)? | local county government |
| Persumptive Eligilibity | benifit that allows individuals to be enrolled in Medicaid for a limited time before the application is filed and processed |
| Who mandated Medicare and who administeres it | Federally mandated, state administered |
| Within federal guidelines each state does what? | establishes eligibility standards, determines the type amount duration and scope of services, sets rates of payment for services and administers its own program |
| are each states programs the same | no, each state determines their own programs |
| Categorically Needy Groups | TANF, pregnant women and children under 6, caregivers, SSI recipients, Individuals and couples living in medical institutions |
| Medically Needy Program | Spend down (per month deductable), pregnant women through 60 days postpartum, children under 18, newborns for 1 year, blind persons |
| Qualified Medicare beneficiary (QMB) | state pays Medicare premiums, deductable and coinsurance amounts for those under the poverty level |
| Qualified working disabled individuals (QWDI) | state pays Medicare Part A premimums for individuals under the federal poverty level |
| Specified low-income Medicare beneficiary (SLMB) | state pays Medicare Part B premiums |
| State Children's Health Insurance Program (SCHIP) | state creat or expand existing insurance progrsm providing more federal funds to states to include a greater bnumber of uninsured children |
| Special Groups | QMB, QWDI, SLMB |
| Medicare Catastrophic Coverage Act of 1988 (MCCA) | implemented spousal impovershment protection to prevent married couples form beign required to spend down income and other liquid assets (cash & property) before one of the partners could be declaired eligible for Medicaid coverage for nurshing home care |
| To receive federaly matching funds the state must offer what service? | Family planning services & supplies |
| Who is a participating provider? | any provider who accepts a medicaid patiens must accept the Medicaid determined paymetn as payment in full |
| Monthly Survey letter | random survey requesting verification of services paid the parevious month |
| What would cause a patient to be eligible one month and not the next? | change in income |
| What must be attached to the Medicaid claim when there is a primary insurance? | Remittance advice from the primary coverage |
| How long is an infant of a Medicaid mother automatically eligible for Medicaid? | the first year of life |
| When claims are submitted under mother's id number coverage is limited to how long. | first 10 days of life |
| how many claim forms must be submitted for a birth? | two, one for mother and one form infant using mother's id # |
Created by:
theresav