Deck 8: Understanding Medicaid

Question 1

Under the DRA,the cost-share amount a state can charge an individual is based on his or her:

A) age.
B) marital status.
C) income.
D) all of the above

Answer 1

income.

Question 2

In order to be eligible for SSI,the individual must meet all of the following criteria,except:

A) be at least 65 years old or blind.
B) have limited resources.
C) be disabled.
D) be single.

Answer 2

be single.

Question 3

The Affordable Care Act provides Americans with opportunities for better healthcare by:

A) expanding coverage.
B) lowering healthcare costs.
C) guaranteeing more choices in healthcare coverage.
D) all of the above

Answer 3

all of the above

Question 4

In order for federal matching funds in a state's Medicaid program to be received,Title XIX of the Social Security Act requires that states offer certain basic services called:

A) monitoring.
B) service matching.
C) mandated services.
D) Medicaid equalization.

Question 5

The acronym for the Medicaid program that was formerly referred to as AFDC is:

A) TANF.
B) HIPAA.
C) COBRA.
D) TRICARE.

Question 6

When an individual is covered under both Medicaid and Medicare and/or a private healthcare policy,the payer of last resort is always:

A) Medicare.
B) Medicaid.
C) Medigap.
D) the private insurer.

Question 7

An individual who is eligible for both Medicare and Medicaid programs is said to be a/an:

A) dual eligible.
B) dual qualifier.
C) elderly qualifier.
D) tax exempt aged.

Question 8

To qualify for supplemental security income (SSI),individuals must meet certain financial guidelines set by:

A) the U.S. Constitution.
B) individual state laws.
C) the federal poverty level (FPL).
D) the Centers for Medicare and Medicaid Services (CMS).

Question 9

When one state allows Medicaid beneficiaries to be treated in an adjacent state,it is referred to as:

A) illegal.
B) joint care.
C) reciprocity.
D) dual state eligibility.

Question 10

Individuals who receive medical assistance because their income falls within the poverty or FPL guidelines or as a result of SSI eligibility are considered:

A) medically needy.
B) medically deprived.
C) categorically needy.
D) medically challenged.

Question 11

A commercial insurer contracted by the Department of Health and Human Services (HHS)for the purpose of processing and administering Medicaid claims is a:

A) claims contractor.
B) Medicaid contractor.
C) commercial advisor.
D) Medicaid administrator.

Question 12

The acronym for the program that provides comprehensive alternative care for noninstitutionalized elderly who otherwise would be in a nursing home is:

A) PACE.
B) COBRA.
C) SCHIP.
D) EMTLA.

Question 13

Medically needy individuals can reduce their assets to the Medicaid eligibility level by deducting medical expenses;this is called a/an:

A) use tariff.
B) spend down.
C) expense equalization.
D) medical expense payout.

Question 14

When a Medicaid beneficiary has no other healthcare coverage,the type of claim to be submitted is called a _____ claim.

A) state
B) unilateral
C) functional
D) Medicaid simple

Question 15

A combination federal/state medical assistance program that provides comprehensive and quality medical care for certain categories of low-income and qualifying elderly people is:

A) Medicare.
B) Medicaid.
C) CHAMPVA.
D) Blue Cross and Blue Shield.

Question 16

The Deficit Reduction Act (DRA)of 2005 provided states with the option of imposing ________ to certain categories of Medicaid recipients.

A) cost-sharing charges
B) premiums
C) taxes on medical benefits
D) both a and b

Question 17

Hospitals that receive additional payments to ensure that communities have access to certain high-cost services are called:

A) trauma centers.
B) disproportionate share hospitals.
C) hospice facilities.
D) full-service medical centers.

Question 18

As a general rule,Medicaid pays only for services that are determined to be:

A) over $100.
B) experimental.
C) federally mandated.
D) medically necessary.

Question 19

Before providing services to patients claiming to be on Medicaid,the health insurance professional should:

A) complete a claim.
B) verify eligibility.
C) check references.
D) ask for payment upfront.

Question 20

The Medicaid program is administered by the:

A) AMA.
B) CMS.
C) HIPAA.
D) NAFTA.

Question 21

A comprehensive federal policy established to prevent and reduce provider fraud,waste,and abuse in the Medicaid program.

A) Means test program
B) Third-party liability
C) Medicaid Integrity Program
D) Medicaid pay and chase

Question 22

The legal obligation of other insuring entities to pay all or part of the healthcare expenses of a Medicaid beneficiary is called:

A) pay or chase.
B) third-party liability.
C) payer of last resort.
D) reciprocity.

Question 23

Some Medicaid services require:

A) a copayment.
B) prior approval.
C) preauthorization.
D) all are correct

Question 24

Groups exempt from paying premiums and cost sharing include all,except:

A) pregnant women.
B) those admitted to hospitals.
C) children.
D) those in hospice.

Question 25

Provisions of the Affordable Care Act expanded Medicaid to all Americans under age 65 whose family income was at or below 133% of the federal poverty level (FPL)beginning the year

A) 2010.
B) 2012.
C) 2013.
D) 2014.

Question 26

A new rule under the DRA that imposes copayments and premiums to certain categories of Medicaid recipients is referred to as ___________.

Question 27

Identify which of the following typically does not fall under the "mandatory" services that must be offered to categorically needy Medicaid beneficiaries.

A) Inpatient hospital services
B) Physician services
C) Optometrist services and eyeglasses
D) Laboratory and x-ray services

Question 28

CMS defines quality as:

A) free healthcare for every needy individual.
B) compulsory best practices.
C) preventive care for those who need it most.
D) the right care for every person every time.

Question 29

Medicaid allows private individuals (or their families)to use their medical expenses to deplete their finances to the point where the individual or family becomes eligible for Medicaid assistance.This is called:

A) spend down.
B) balance billing.
C) dual coverage.
D) income limiting.

Question 30

The time limit for filing Medicaid claims varies from state to state but is typically _________.

Question 31

What kind of a claim is generated when the beneficiary has two types of healthcare coverage?

A) Medicaid simple claim
B) Medicare secondary claim
C) Medicaid secondary claim
D) Disproportionate share claim

Question 32

The optional services authorized by the Medicaid Act include:

A) clinic services.
B) physical therapy.
C) dentures.
D) all of the above

Question 33

It is good practice to file all Medicaid claims:

A) in a timely manner.
B) within 2 years of the date of services.
C) after the patient has been released from medical care.
D) within 6 months.

Question 34

A state option that provides individuals with disabilities who are eligible for nursing homes and other institutional settings with options to receive community-based services.

A) Community First Choice Option
B) Elderly Community Housing Program
C) Medicaid Integrity Option
D) Qualified Medicaid Beneficiary Option

Question 35

The Medicaid program,referred to in the past as Aid to Families with Dependent Children (AFDC),is now called:

Question 36

The health insurance professional should check with the Medicaid contractor in his or her state for the _____________ deadline.

Question 37

Providers can reduce the number of denied claims by using:

A) cost sharing.
B) eligibility verification systems.
C) paper claim forms.
D) Medicaid contractors.

Question 38

The legal obligation of other insurance policies/programs to pay all or part of the expenditures for medical assistance furnished under a state plan is referred to as ____________________.

Question 39

Every time a claim is sent to Medicaid,a document is generated explaining how the claim was adjudicated,or how the payment was determined,which is called a:

A) crossover.
B) explanation of services.
C) payment resolution.
D) remittance advice.

Question 40

When a healthcare provider engages in intentional misrepresentation or deception that could result in an unauthorized benefit to an individual,it is called:

A) fraud.
B) abuse.
C) negligence.
D) malpractice.

Question 41

What is Medicaid?

Question 42

In 1972 federal law established the ______________program,which provides federally funded cash assistance to qualifying elderly and disabled poor.

Question 43

As a general rule,Medicaid only pays for services that are determined to be medically necessary.Give a definition of "medically necessary."

Question 44

In 1972 federal law established the supplemental security income (SSI)program.What does it provide?

Question 45

List the qualifications one must have to qualify for SSI.

Question 46

List four examples of third parties that may be liable to pay for services before Medicaid pays.

Question 47

Congress established the Medicaid program under Title XIX of the Social Security Act in 1965.

Question 48

_____________ is where the healthcare provider bills and collects from liable third parties before sending the claim to Medicaid.

Question 49

Under which federal act was the Medicaid program established?

Question 50

Facilities that receive additional payments to ensure that communities have access to certain high-cost services such as trauma and emergency care and burn services are called ______________.

Question 51

There is a Medicaid program in all 50 states,the District of Columbia,and U.S.territories.

Question 52

Briefly explain the difference between the Medicare and Medicaid programs.

Question 53

List four possible methods for verifying Medicaid eligibility.

Question 54

Every state has the same Medicaid benefits.

Question 55

Write a brief summary of the development and structure of Medicaid

Question 56

Discuss Medicaid Quality Practices

Question 57

List at least five of the federally mandated services under the Medicaid program.

Question 58

The name of the law Congress enacted in 1996 to ensure public access to emergency services regardless of ability to pay is:

Question 59

List typical responsibilities of a Medicaid contractor (fiscal intermediary).

Question 60

The ____________ program provides comprehensive alternative care for non-institutionalized elderly who otherwise would be in a nursing home.

Question 61

To qualify for Medicaid,the individual must be at least 65 years of age.

Question 62

CMS determines eligibility criteria for SSI.

Question 63

Hospitals that receive additional payments to ensure that communities have access to certain high-cost services are called disproportional share hospitals.

Question 64

The federal government establishes broad national guidelines for Medicaid eligibility and each state establishes its own eligibility standards within federal guidelines.

Question 65

Most states have their own specific form to use for Medicaid claims.

Question 66

All states provide healthcare coverage to pregnant women with qualifying family income.

Question 67

One method of verifying Medicaid eligibility is the "automated voice response system."

Question 68

States must cover categorically needy individuals but are free to define this category.

Question 69

Groups who are exempt from paying cost shares of fees and/or premiums are limited to children.

Question 70

States that offer a medically needy program must cover pregnant women and their children regardless of age.

Question 71

Every time a Medicaid claim is submitted,a document called a remittance advice (RA)is generated.

Question 72

States may combine the administration of Medicaid with other programs,such as CHIP.

Question 73

In most states,SSI beneficiaries also qualify for Medicaid assistance to pay for hospital stays,doctor bills,prescription drugs,and other health costs.

Question 74

Medicaid payments are normally sent directly to the provider and "balance billing" is not allowed.

Question 75

Medicaid recipients who qualify for benefits in January will qualify for the remainder of the year.

Question 76

Providers are not permitted to withhold care or services to individuals even when they do not meet their cost-sharing obligations.

Question 77

There is an ongoing effort in the United States to make healthcare available to more and more uninsured people-particularly children.

Question 78

All healthcare providers in all states must accept Medicaid patients.

Question 79

Medicaid programs have a fee-for-service coverage structure;there is no managed care option in any state.Medicaid is the largest source of funding for "safety-net" providers that serve the poor and uninsured.

Question 80

States have the option to charge higher copayments for people who visit a hospital emergency department for treatment of a condition that is not considered a true emergency.