Exam 13: Medicaid Medical Billing

When filing a claim for a newborn boy baby whose mother is Jane Doe, the name field of the claim form should state:

Although not recommended, hospitals reimbursed according to diagnostic-related group (DRG) payment methodology may submit an interim claim if the client has been in a facility for:

If a Medicaid patient is on restricted status, the patient is required to see a specific physician and/or to use a specific pharmacy.

In regard to Medicaid managed care, what does the term medical home mean?

Providers must resubmit a signed, completed/corrected claim with a copy of the R&S on which the denied claim appears within 180 days from the date of the R&S to be considered for payment.

The organization responsible for determining the type, amount, and scope of services covered by Medicaid is:

Match the following: -The law that created the federal-state entitlement program known as Medicaid

Mandatory Medicaid services do not include which of the following?

Programs of All-Inclusive Care for the Elderly (PACE) providers agree to make all services available to beneficiaries without any cost-sharing requirements.

A physician may bill a Medicaid patient for services if the:

Match the following: -The federal program that provides states with grants for time-limited cash assistance for needy families

The code S2 used in form locator 24H in regard to early and periodic screening, diagnosis, and treatment (EPSDT) services means :

The early and periodic screening, diagnosis, and treatment (EPSDT) program includes coverage for children younger than age:

The medical office specialist should verify a patient's Medicaid eligibility:

The goal of Medicaid managed care is:

List the roles of individual states in developing their state Medicaid program.

In form locator 24H EPSTD Family Plan, which code is used when a patient refused a referral?

Match the following: -The law that restricted eligibility for Supplemental Security Income (SSI) and Medicaid coverage for legal resident aliens

The federal-state program that provides medical benefits to specific groups of low-income people is ________.

A type of Medicaid managed care plan can involve a health maintenance organization that contracts with Medicaid and is paid a monthly fee for each enrolled beneficiary; this payment arrangement is known as ________.