Exam 14: Medicaid Medical Billing

A person eligible for Medicaid in one state is automatically eligible in all other states.

A type of noncapitated Medicaid managed care plan in which participants must select a primary care physician is known as primary care __________ .

What must states file with CMS to request permission to make changes in the design and implementation of their Medicaid programs? A)Payment request B)Authorization request C)Waiver request D)Certification request

The federal government reimburses states for the cost of services provided by Indian Health Service facilities at a rate of: A)0%. B)50%. C)75%. D)100%.

Claims filed by a hospital for inpatient services must be received by Medicaid within 95 days of the discharge date.

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

The medical office specialist should verify a patient's Medicaid eligibility: A)at every visit. B)twice a month. C)every 2 months. D)every 6 months.

The goal of the Children's Health Insurance Program Reauthorization Act (CHIPRA) is to expand Medicaid eligibility to more: A)children with disabilities. B)working individuals without insurance. C)children without health insurance. D)immigrants.

The federal government matches state expenditures for medical assistance with no set limit or cap.

The early and periodic screening, diagnosis, and treatment (EPSDT) program provides coverage for: A)early and preventative services for dependency treatment. B)easy periodic screening for dependents' treatment. C)early and periodic screening, diagnosis, and treatment. D)early and preventative services for diagnosis and treatment.

The abbreviation PCCM used in regard to Medicaid managed care plans stands for: A)per case care management. B)preventive care case management. C)primary care case management. D)primary coverage and care management.

Which type of nominal cost sharing can states require of most Medicaid beneficiaries? A)Deductibles B)Coinsurance C)Copayments D)Premiums

Under a primary care case management (PCCM) arrangement, primary care physicians are paid on a: A)monthly capitation basis. B)monthly capitation basis plus a case-management fee. C)fee-for-service basis. D)fee-for-service basis plus a case-management fee.

What is the definition of medically needy?

Which groups of people are eligible for Medicaid benefits?

Types of supplemental information that can be included in the shaded lines of form locator 24 include all of the following EXCEPT: A)contract rate. B)national drug codes. C)anesthesia duration. D)explanation of modifier -99.

Legal resident aliens who entered the United States after 1996 are eligible for Medicaid after __________ years.

What is the EPSDT program?

For a dependent 6-year-old child, form locator 6 should indicate that the patient's relationship to the insured is: A)self. B)child. C)dependent. D)other.

State legislators cannot make changes in Medicaid eligibility or services.