Deck 14: Medicaid Medical Billing

Question 1

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.

Answer 1

all of the above.

Question 2

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.

Answer 2

early and periodic screening, diagnostic, and treatment services for children younger than age 21.

Question 3

The goal of the Children's Health Insurance Program Reauthorization Act (CHIPRA) is to expand Medicaid eligibility to more:

A)children with disabilities.
B)working individuals without insurance.
C)children without health insurance.
D)immigrants.

Answer 3

children without health insurance.

Question 4

Groups included as eligible for Medicaid include:

A)the categorically needy.
B)the medically needy.
C)special groups.
D)all of the above.

Question 5

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.

Question 6

Under the Welfare Reform Bill, mandatory covered services for immigrants include:

A)prenatal care.
B)well-child checkups.
C)emergency services.
D)preventive services.

Question 7

Medicaid is paid for by:

A)the local government.
B)the federal government.
C)the state government.
D)the federal and state government.

Question 8

Which type of nominal cost sharing can states require of most Medicaid beneficiaries?

A)Deductibles
B)Coinsurance
C)Copayments
D)Premiums

Question 9

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.

Question 10

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.

Question 11

Medicaid is health insurance coverage for:

A)the aged.
B)the disabled.
C)low-income individuals.
D)those with end-stage renal disease (ESRD).

Question 12

Eligibility for Temporary Assistance for Needy Families (TANF) is determined by the:

A)city.
B)county.
C)state.
D)nation.

Question 13

A physician may bill a Medicaid patient for services if the:

A)service was not medically necessary.
B)patient signed an advance beneficiary notice (ABN).
C)claim was not filed in a timely manner.
D)necessary preauthorization was not obtained.

Question 14

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.

Question 15

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.

Question 16

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.

Question 17

The early and periodic screening, diagnosis, and treatment (EPSDT) program provides coverage for:

A)early and preventative services for dependency treatment.
B)easy periodic screening for dependents' treatment.
C)early and periodic screening, diagnosis, and treatment.
D)early and preventative services for diagnosis and treatment.

Question 18

The largest funding for healthcare for America's low-income individuals comes from:

A)Medicare.
B)Medicaid.
C)private insurance.
D)individuals.

Question 19

Mandatory Medicaid services include which of the following?

A)Inpatient hospital services
B)Nurse-midwife services
C)Optometrist services
D)Vaccines for children

Question 20

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.

Question 21

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.

Question 22

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.

Question 23

Under a primary care case management (PCCM) arrangement, primary care physicians are paid on a:

A)monthly capitation basis.
B)monthly capitation basis plus a case-management fee.
C)fee-for-service basis.
D)fee-for-service basis plus a case-management fee.

Question 24

Due to the Affordable Care Act of 2010, millions more low-income Americans will be eligible for Medicaid coverage as of:

A)2013.
B)2014.
C)2015.
D)2016.

Question 25

What must states file with CMS to request permission to make changes in the design and implementation of their Medicaid programs?

A)Payment request
B)Authorization request
C)Waiver request
D)Certification request

Question 26

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.

Question 27

Those Medicaid beneficiaries who are excluded from cost-sharing provisions include:

A)the blind.
B)the elderly.
C)pregnant women.
D)the disabled.

Question 28

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.

Question 29

The federal government matches state expenditures for:

A)mandatory services.
B)state optional services.
C)administrative costs.
D)all of the above.

Question 30

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.

Question 31

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."

Question 32

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.

Question 33

The federal government reimburses states for the cost of services provided by Indian Health Service facilities at a rate of:

A)0%.
B)50%.
C)75%.
D)100%.

Question 34

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.

Question 35

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.

Question 36

The abbreviation PCCM used in regard to Medicaid managed care plans stands for:

A)per case care management.
B)preventive care case management.
C)primary care case management.
D)primary coverage and care management.

Question 37

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.

Question 38

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.

Question 39

The medical office specialist should verify a patient's Medicaid eligibility:

A)at every visit.
B)twice a month.
C)every 2 months.
D)every 6 months.

Question 40

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%

Question 41

A person eligible for Medicaid in one state is automatically eligible in all other states.

Question 42

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

Question 43

The code ST used in form locator 24H in regard to early and periodic screening, diagnosis, and treatment (EPSDT) services means:

A)services were not available.
B)services were available and used.
C)new services were requested.
D)services were available but not authorized.

Question 44

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.

Question 45

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).

Question 46

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.

Question 47

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.

Question 48

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

Question 49

For a dependent 6-year-old child, form locator 6 should indicate that the patient's relationship to the insured is:

A)self.
B)child.
C)dependent.
D)other.

Question 50

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

Question 51

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

Question 52

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)

Question 53

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.

Question 54

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

Question 55

State legislators cannot make changes in Medicaid eligibility or services.

Question 56

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.

Question 57

Providers participating in Medicaid must accept the Medicaid payment rate as payment in full and cannot balance-bill the patient.

Question 58

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.

Question 59

Types of supplemental information that can be included in the shaded lines of form locator 24 include all of the following EXCEPT:

A)contract rate.
B)national drug codes.
C)anesthesia duration.
D)explanation of modifier -99.

Question 60

States determine the amount and duration of Medicaid services and can set limits based on medical diagnoses or conditions.

Question 61

Most states provide electronic verification of Medicaid eligibility.

Question 62

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

Question 63

Legal resident aliens who entered the United States after 1996 are eligible for Medicaid after __________ years.

Question 64

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

Question 65

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

Question 66

Claims filed by a hospital for inpatient services must be received by Medicaid within 95 days of the discharge date.

Question 67

The federal-state program that provides medical benefits to specific groups of low-income people is __________ .

Question 68

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

Question 69

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

Question 70

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

Question 71

If a Medicaid patient is on restricted status, the patient is required to see a specific physician and/or to use a specific pharmacy.

Question 72

A type of noncapitated Medicaid managed care plan in which participants must select a primary care physician is known as primary care __________ .

Question 73

Medicaid patients enrolled in managed care plans must select a primary care provider.

Question 74

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 __________ .

Question 75

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

Question 76

The federal government matches state expenditures for medical assistance with no set limit or cap.

Question 77

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

Question 78

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

Question 79

If a Medicaid claim was NOT filed within the required time limits because of an error or neglect on the part of the medical office staff, the physician can appeal the denial and seek payment.

Question 80

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