Deck 10: Medicaid

Question 1

Under the Medicaid program, if there is any difference between fees charged for services and the amount reimbursed, who pays the difference?

A) physician must write off the difference
B) secondary insurance
C) patient pays out of pocket
D) the state

Answer 1

physician must write off the difference

Question 2

In which way do states participate in Medicaid programs?

A) determine eligibility
B) authorize additional kinds of services
C) determine amount patient pays out of pocket
D) determine eligibility and authorize additional kinds of services

Answer 2

determine eligibility and authorize additional kinds of services

Question 3

Who should be contacted for preauthorization requirements?

A) TANF
B) CMS
C) state's fiscal agent
D) federal fiscal agent

Answer 3

state's fiscal agent

Question 4

The Children's Health Insurance Program (CHIP) covers children until what age?

A) 16
B) 19
C) 21
D) 26

Question 5

When are provisions affecting Medicaid enrollment under the Affordable Care Act expected to take effect?

A) 2013
B) 2014
C) 2015
D) it has already taken effect

Question 6

Which is the electronic claim format accepted by Medicaid?

A) HIPAA 837
B) CMS-1500
C) both HIPAA 837 and CMS-1500
D) neither HIPAA 837 nor CMS-1500

Question 7

Which is not an example of Medicaid fraud?

A) billing with false credentials
B) billing for tests that are not medically necessary
C) billing for phantom patients
D) billing for dental benefits

Question 8

When should eligibility be checked under the Medicaid program?

A) every month
B) every 6 months
C) before each visit
D) every year

Question 9

What are some of the benefits cuts of Medicaid that have taken place due to budget?

A) family planning
B) routine visits
C) prescription drugs
D) family planning and routine visits

Question 10

Who chooses if a physician participates in the Medicaid program?

A) the physician
B) the state
C) federal law requires all providers to participate
D) the patient

Question 11

What is the timeline for filing a Medicaid claim?

A) 1 month
B) 1 year
C) there is no timeline
D) it varies by location

Question 12

In addition to deductibles, what might a Medicaid recipient in the medically needy classification need to pay for medical services?

A) copay
B) coinsurance
C) fee-for-service
D) nothing

Question 13

In order to lower costs, which service might be subject to a reduction in payment?

A) mental health services
B) prescription drugs
C) prosthetic devices
D) nursing homes

Question 14

Which regulation initiated the first Medicaid programs?

A) Affordable Care Act
B) Social Security Act of 1965
C) Temporary Assistance to Needy Families
D) Medical Alliance for program safeguards

Question 15

If a patient lives on the state border of Florida and sees a physician in Georgia, to whom should the provider send the claim?

A) Medicaid central processing
B) Georgia
C) Florida
D) either Georgia or Florida

Question 16

What is MediCal?

A) a Medicare program
B) Medicaid of California
C) Medicaid of Colorado
D) none of these

Question 17

Which program expands the availability of health care services for workers with disabilities?

A) TWWIIA
B) CMS
C) CHIP
D) TANF

Question 18

Which type of program best describes the Medicaid program?

A) insurance program
B) discount plan
C) assistance program
D) charity care

Question 19

Which of the following services is Medicaid more likely to pay for?

A) transportation to medical care
B) non-formulary medications
C) daycare so that a parent can work
D) research for a drug

Question 20

What is the proper way to send a claim when a patient has both Medicare and Medicaid coverage?

A) on a paper form with documentation attached
B) with an EOB
C) with a remittance advice
D) it is automatically crossed over

Question 21

In order to fund Medicaid, how does the federal government determine the amount to contribute to the states?

A) FMAP
B) CMS
C) previous year's medical expenses
D) calculates a correlation to Social Security benefits

Question 22

If a patient is covered by both Medicare and Medicaid, what determines primary eligibility?

A) Medicaid is primary
B) Medicare is primary
C) their age
D) the physician determines which is first

Question 23

State Medicaid programs have to provide benefits for what services?

A) physician services
B) children's physical exams
C) dental services
D) both physician services and children's physical exams

Question 24

State Medicaid programs do not have to cover which of these services?

A) physician services
B) children's physical exams
C) experimental procedures
D) both physician services and children's physical exams

Question 25

An organization that processes claims for a government program is called a

A) fiscal agent
B) payer of last resort
C) processing agent
D) both fiscal agent and processing agent

Question 26

The obligation of an insurance plan or government program to pay all or part of medical costs is referred to as

A) categorically needy
B) medically needy
C) third-party liability
D) federal liability

Question 27

By law, Medicaid is known as the payer of

A) primary insurance
B) secondary insurance
C) Welfare participants
D) last resort

Question 28

From where does Medicaid receive its funding?

A) the federal government
B) state governments
C) Medicare
D) both the federal government and state governments

Question 29

Under Medicaid, states offer

A) fee-for-service plans
B) managed care plans
C) both fee-for-service plans and managed care plans
D) neither fee-for-service plans nor managed care plans

Question 30

Under Medicaid, when can physicians bill patients for the difference between the Medicaid payment and their normal charge?

A) under any circumstances
B) under the appropriate circumstances
C) under no circumstances
D) under extenuating circumstances

Question 31

Medicaid pays for health care services for people

A) who are over 65 years of age
B) with incomes below the national poverty level
C) who are permanently disabled
D) All of these

Question 32

The federal government makes payments to states under the FMAP, which stands for

A) Federal Medicaid Assistance Percentage
B) Financial Medicaid Assistance Performance
C) Federal Medicare Assistance Percentage
D) Financial Medicare Assistance Performance

Question 33

According to federal guidelines, Medicaid pays for what types of health care?

A) family planning services
B) home health care
C) emergency care
D) All of these

Question 34

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is a prevention, early-detection, and treatment program, for people enrolled in Medicaid, under the age of

A) 18
B) 21
C) 40
D) 65

Question 35

The Children's Health Insurance Program (CHIP) requires states to develop and implement plans for health insurance coverage for

A) unemployed adults
B) orphaned children
C) uninsured children
D) unemployed children

Question 36

Medicaid recipients with very low or no incomes are known as

A) categorically needy
B) medically needy
C) fiscal agents
D) None of these

Question 37

Medicaid recipients who earn enough money to pay for basic living expenses, but cannot afford high medical bills are known as

A) categorically needy
B) medically needy
C) fiscal agents
D) None of these

Question 38

The needs of categorically needy people are addressed by

A) SCHIP
B) TANF
C) the Welfare Reform Act
D) they are not covered

Question 39

When filing Medicaid claims for any state, the medical assistant should pay special attention to

A) preauthorization requirements
B) the filing deadline
C) eligibility
D) All of these

Question 40

The obligation of a government program or insurance plan to pay all or part of a patient's medical costs is known as

A) fiscal responsibility
B) third-party liability
C) preauthorization
D) None of these

Question 41

Because claims are filed first with the primary carrier, and filed for Medicaid benefits last, Medicaid is referred to as the

A) payer of last resort
B) final option
C) end of payment
D) fiscal agent

Question 42

Which act contributed to the development of the Children's Health Insurance Program (CHIP)?

A) Health Insurance Program (CHIP)
B) Affordable Care Act
C) Balanced Budget Act of 1997
D) Social Security Act of 1965

Question 43

If a patient was approved for a preauthorization for additional services, who funds the services?

A) patient
B) federal
C) state
D) state and federal

Question 44

What is a new verification of eligibility method many states are incorporating?

A) EMEVS
B) FMAP
C) CMS
D) EPSDT

Question 45

What type of Medicaid plan restricts patients to a network of physicians, hospitals, and clinics?

A) fee-for-service
B) managed care plans
C) capitation
D) point-of-service

Question 46

Under what type of Medicaid plan may thepatients be treated by the provider of their choice, as long as that provider accepts Medicaid?

A) fee-for-service
B) managed care plans
C) capitation
D) point-of-service

Question 47

Where are Medicaid managed care claims sent?

A) state fiscal agent
B) managed care plan
C) state Medicaid department
D) federal government

Question 48

Where are claims sent for Medicaid?

A) state fiscal agent
B) managed care plan
C) state Medicaid department
D) federal government

Question 49

What does the Affordable Care Act requires for coverage?

A) the non-elderly
B) incomes below 133 percent of the poverty level
C) both non-elderly and below 133 percent of the poverty level
D) either non-elderly or below 133 percent of the poverty level

Question 50

Which of the following services is Medicaid not likely to pay for?

A) a second opinion
B) nurse-midwife services
C) family planning services
D) transportation to medical care

Question 51

Who oversees the programs that are administered by the states?

A) federal government
B) Centers for Medicare and Medicaid Services
C) state fiscal agent
D) Center for Medicaid and State Operations

Question 52

What is not covered by Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)?

A) sickle cell trait and disease
B) mental evaluations
C) lead absorption
D) dental problems

Question 53

Why might it be difficult for Medicaid patients to a find a physician who will treat them?

A) lower fee structure
B) restricted network
C) difficult credentialing process
D) confusing system

Question 54

What is necessary for payment of emergency care?

A) referral number
B) Service Authorization Exception Code
C) preauthorization code
D) emergency care is covered with authorization

Question 55

Which program is committed to fighting fraud and abuse in Medicaid?

A) state fiscal agent
B) Centers for Medicare and Medicaid Services
C) Medicaid Alliance for Program Safeguards
D) Department of Justice

Question 56

Which guidelines do participating providers abide by for a managed care plan of Medicaid?

A) managed care organization
B) state Medicaid regulations
C) both managed care organization and federal requirements
D) neither managed care organization nor state Medicaid regulations

Question 57

How is the federal contribution for Medicaid calculated?

A) based on the population under 133% of the poverty level
B) it correlates with the national debt
C) state's gross domestic product average
D) state's average per capita income in relation to the national income average

Question 58

Ticarey is a child who has sickle cell anemia. His father is disabled, but works enough to provide for day-to-day expenses excluding healthcare. Under which act/plan is Ticarey eligible for coverage?

A) EPSDT
B) TWWIIA
C) TANF
D) EMEVS