Exam 14: Medicaid Medical Billing

In some states, a spend-down program requires that individuals must spend a portion of their income or resources each month on medical expenses before: A)Medicare begins paying for services. B)Medicaid begins paying for services. C)a deductible is paid. D)a coinsurance amount applies.

The federal government makes payments to states for a portion of the cost of medical services provided to Medicaid beneficiaries under the __________ program.

The form signed by a patient that states the amount and reason why a procedure is NOT covered by Medicaid is a(n) __________ notice.

In regard to Medicaid managed care, what does the term medical home mean? A)The PCP serves as the "medical home" by coordinating care and controlling costs. B)The "medical home" is the city or town in which the beneficiary receives services. C)The "medical home" is any type of inpatient facility, such as a hospital or skilled nursing facility, to which a beneficiary has been admitted. D)The beneficiary's primary place of residence is the "medical home."

A copayment may NOT be collected from a Medicaid patient for: A)hospital services. B)family planning services. C)physician office visits. D)preventive care services.

Under the Welfare Reform Bill, mandatory covered services for immigrants include: A)prenatal care. B)well-child checkups. C)emergency services. D)preventive services.

The code S2 used in form locator 24H in regard to early and periodic screening, diagnosis, and treatment (EPSDT) services means: A)services were not available. B)new services were requested. C)the patient is currently under treatment. D)services were available and used.

Appeals of denied claims or claim adjustments must be filed within: A)95 days from the date of service. B)95 days from the date of disposition. C)180 days from the date of disposition. D)180 days from the date of service.

To what does the term Medi-Medi refer?

If Medicaid does NOT cover a service, under what conditions can a provider bill the patient?

Due to the Affordable Care Act of 2010, Medicaid expenditures are expected to increase by how much over earlier projections? A)3% B)5% C)8% D)10%

Most Medicaid plans do NOT require beneficiaries to pay a premium.

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

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

Mandatory Medicaid services include which of the following? A)Inpatient hospital services B)Nurse-midwife services C)Optometrist services D)Vaccines for children

When reporting National Drug Code (NDC) units on a Medicaid claim, the qualifiers would include all of the following EXCEPT: A)F2 (international unit). B)GR (gram). C)OZ (ounce). D)ML (milliliter).

If an individual is covered by both Medicaid and Medicare: A)Medicare is always primary. B)Medicaid is always primary. C)Medicaid is primary only if the individual is younger than 65. D)Medicare is primary only if the individual is younger than 65.

Healthcare Common Procedure Coding System (HCPCS) codes are required on both Medicaid physician and hospital claim forms.

How is form locator 10d: Reserved for Local Use used for Medicaid claims? A)To indicate that an attachment is included with the claim B)To indicate the address of the local carrier C)To indicate that an affidavit has been filed D)Form locator 10d is not used by Medicaid.

Early and periodic screening, diagnosis, and treatment (EPSDT) services include coverage for: A)well-child checkups. B)vision screening. C)dental screening. D)all of the above.