Exam 14: Medicaid Medical Billing

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 __________ .

The goal of Medicaid managed care is: A)to increase access to care. B)to reduce service fragmentation. C)to reduce costs. D)to stimulate appropriate use of services.

What are the restrictions that apply to states that limit Medicaid services?

When filing a claim for a newborn boy baby whose mother is Jane Doe, the name field of the claim form should state: A)Newborn Male Doe. B)Baby Boy Doe. C)Boy Jane Doe. D)Newborn Baby Boy.

If a Medicaid patient is on restricted status when eligibility is verified, the patient is required to: A)receive only certain services. B)receive services only from a specific provider. C)obtain authorization for all services. D)obtain services only in cases of an emergency.

Hospitals are NOT permitted to submit interim claims for Medicaid patients while they are still hospitalized.

What is PACE?

The federal government matches state expenditures for: A)mandatory services. B)state optional services. C)administrative costs. D)all of the above.

For supplemental information entered in form locator 24, the qualifier ZZ indicates: A)anesthesia information. B)a narrative description of an unspecified code. C)a National Drug Code. D)the contract rate.

To be considered for payment, Medicaid claims must be received within: A)65 days from the date of service. B)95 days from the date of service. C)180 days from the date of service. D)1 year from the date of service.

Care provided under the PACE program can be rendered in: A)nursing homes. B)hospitals. C)the patient's home. D)all of the above.

To be considered for payment, a denied Medicaid claim must be appealed within 60 days of the date of denial notification.

Two managed care models implemented in state Medicaid programs include: A)HMOs and POS. B)HMOs and PCCM. C)POS and PCCM. D)PPOs and POS.

All Medicaid beneficiaries are exempt from copayments for __________ and __________ services.

To qualify for federal matching funds for the medically needy, states must include coverage for: A)pregnant women. B)the elderly. C)the blind. D)the disabled.

The cost of Medicaid benefits has been decreasing rapidly since the 1990s.

Physician services claims are filed using the: A)UB-04 claim form. B)CMS-1500 claim form. C)UB-92 claim form. D)Medicaid PCCM claim form.

Groups included as eligible for Medicaid include: A)the categorically needy. B)the medically needy. C)special groups. D)all of the above.

Medicaid is health insurance coverage for: A)the aged. B)the disabled. C)low-income individuals. D)those with end-stage renal disease (ESRD).