Exam 14: Medicaid Medical Billing

As a result of the Welfare Reform Bill, legal resident aliens who entered the United States after 1996 are NOT eligible for Medicaid for 5 years.

The program that provides states with grants to be spent on time-limited cash assistance to low-income families is called __________ .

If a state elects to have a medically needy Medicaid program, it must include coverage for pregnant women.

If a claim is denied by Medicaid because prior authorization was NOT obtained, the physician can bill the patient for the services.

Medicaid is paid for by: A)the local government. B)the federal government. C)the state government. D)the federal and state government.

The category of individuals who would be eligible for Medicaid services but have too much money is known as the __________ .

Which services covered under Medicaid are exempt from copayments?

What document is issued to a Medicaid beneficiary to prove his or her eligibility for benefits? A)Advance Beneficiary Notice (ABN) B)Medicaid waiver C)Medicaid ID card D)Medicaid Remittance and Status (R&S)

The early and periodic screening, diagnosis, and treatment (EPSDT) program includes coverage for children younger than age: A)2. B)6. C)19. D)21.

Mandatory Medicaid services include coverage for: A)early and periodic screening, diagnostic, and treatment services for children younger than age 21. B)physical therapy services. C)prescribed drugs. D)transportation services.

Most states provide electronic verification of Medicaid eligibility.

States will get federal matching funds for categorically needy groups that include all of the following EXCEPT: A)families who meet Eligibility for Temporary Assistance for Needy Families (TANF, formerly AFDC) eligibility requirements. B)children ages 6 to 19 in families with income up to 100% of the federal poverty level. C)caretakers of children younger than age 18. D)individuals age 65 and older.

Optional Medicaid services that are eligible for federal matching funds include all of the following EXCEPT: A)transportation services. B)rehabilitation services. C)acupuncture for pain relief. D)optometrist services and eyeglasses.

The role of the primary care physician in a Medicaid managed care plan is: A)to provide preventive checkups. B)to refer the beneficiary to specialists when necessary. C)to treat the majority of health conditions to the extent possible. D)to coordinate acute and long term care services for patients with complex medical conditions.

States may pay for Medicaid services on a fee-for-service basis or: A)based on the Medicare fee schedule. B)through contracts with managed care organizations. C)using a scale based on the beneficiary's annual income. D)through a per-diem rate.

A low-income individual age 65 or older may be eligible for both Medicare and __________ health insurance coverage.

In a Medicaid managed care plan, the role of the care coordinator is to: A)coordinate all community-based care. B)coordinate all acute and long-term care. C)refer beneficiaries to specialty services. D)enroll beneficiaries in appropriate plans.

Medicaid claims that are denied due to incomplete information can be corrected and resubmitted.

The organization responsible for determining the type, amount, and scope of services covered by Medicaid is: A)the Centers for Medicare and Medicaid Services (CMS). B)the federal government. C)each state government. D)contracted insurance carriers.