Medicaid Test Review
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| UNDER BROAD FEDERAL GUIDELINES | show 🗑
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| PAYER OF LAST RESORT | show 🗑
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| TRUE | show 🗑
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| MEDICAID ELIGIBILITY | show 🗑
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| TRUE | show 🗑
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| show | Temporary Assistance for Needy Families (used to be called AFDC). Provides time-limited cash assistance for children deprived of support because of parent's death, incapacity, absence, or unemployment.
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| show | supplemental security income
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| show | can have out of pocket expenses.
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| show | Quilified Medicare Beneficiaries
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| QWDI | show 🗑
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| If meet income reguirements do not have to pay | show 🗑
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| show | Qualifying individuals
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| SLMB | show 🗑
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| SLMBs do not have to pay | show 🗑
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| SCHIP | show 🗑
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| show | benefit that allow individuals to be enrolled in medicaid for limited time before full medicaid applications are filed and processed.
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| What allows immediate access to services for children who are eligible as well as woman who are in need of treatment for breast or cervical cancer, Eligibility is part of the CDC's national breast and cervival cancer early detection program? | show 🗑
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| show | will provide eligivle children with coverage until the age of 19.
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| Spousal Impoverish Protection | show 🗑
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| show | spouse residing at the home
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| show | EPSDT
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| show | Early and periodic screening, diagnosis, and treatment
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| show | (for mandatory eligibility group)
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| show | (TRUE OR FALSE) Family planning services and supplies (for mandatory eligiblility group)
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| show | preauthorized
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| To request information about the local medicaid program the insurance specialist should contact the | show 🗑
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| show | When an individual has both medicare and medicaid coverage, covered services are paid by medicare first
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| Participating Providers | show 🗑
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| show | eligibility is determined for medicaid recipients with MEVs or REVs
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| show | (TRUE OR FALSE) Eligibility should be verified at each encounter
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| Three ways a payer can cerify medicaid eligibility are: | show 🗑
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| TRUE | show 🗑
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| show | is one that medcaid should not have orginally paid and results in a deduction from the lump-sum payment provider
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| A claim that has had a payment correction is an | show 🗑
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| show | A sample of medicaid recipients is sent a monthly survey letter requesting verification of services paid the previous month on their behalf to help verify receipt of medicaid services.
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| Billing notes | show 🗑
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| show | (TRUE OR FALSE) Medicaid reimbursement information sent to the provider is called remittance advice
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| show | -Co-payments -Deductibles -Non-covered services -Monthly premiums
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| FMAP | show 🗑
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| show | is used for services provided to a baby and submitted under the motyher's medicaid identification number.
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| What claim is used for coverage is usually limited to the baby's first 10 days of life, and during that time an applicaton must be filed so the baby is assigned his/her own identification number. | show 🗑
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| Medicaid eligibility for infants born to medicaid-elgible pregnant woman can | show 🗑
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| show | the remittance advice from the primary payer may need to be submitted as proof of payment or nonpayment
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| If patient has Medicaid and TRICARE, | show 🗑
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| show | (TRUE OR FALSE) The federal government mandates that medicaid remittance advice forms are to be kept by providers for a period set by the state in which they practice.
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| Balanced billing the patient the difference between the charged amoutn and the allowed amount is | show 🗑
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| Individuals classidied as medically needy MAY have | show 🗑
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| Mandatory Federal Eligibility Requirements for Medicaid (1-3 of mandates) | show 🗑
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| Mandatory Federal Eligibility Requirements for Medicaid (4-5 of mandates) | show 🗑
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| Define payer of last resort | show 🗑
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| show | 1. Point-of-point device
2. Computer software
3. Automated voice response
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| What procedure is used to verify receipt of medicaid services | show 🗑
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| Define presumptive eligibility | show 🗑
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| Discuss use mother/baby claim | show 🗑
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| Four out-of-pocket expenses that medicaid patients MAY have to pay | show 🗑
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| show | 1. Idividuals who meet requirements of TANF programs
2. Children under the age of 6 and pregnant women whose family income is at or below 133% of the federal poverty level
3. Supplemental security income recipients
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| show | 4. Individuals and couples living in medical institutions who have a monthly income up to 300% of the SSI income.
5. Caretakers (relatives or legal guardians who take care of children who are under age 18 or 19 if still in school)
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Created by:
cthomp