UHI Medicaid Word Scramble

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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