Question 1

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.

Accepted Answer

The answer of The
role of the primary care physician in...

Question 2

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.

Accepted Answer

The answer of A copayment may NOT be collected from...

Question 3

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.

Accepted Answer

Under a primary care case management (PCCM) arrangement, primary care physicians are typically paid on a fee-for-service basis for the medical services they provide. Additionally, they receive a case-management fee for the administrative and coordination tasks they perform, such as managing referrals and ensuring continuity of care.

Question 4

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.

Accepted Answer

The answer of Due to the Affordable Care Act of...

Question 5

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

Accepted Answer

States must file a waiver request with CMS to request permission to make changes in the design and implementation of their Medicaid programs. Waivers allow states to modify certain Medicaid requirements and receive federal funding for their programs.

Question 6

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.

Accepted Answer

The answer of In a Medicaid managed care plan, the...

Question 7

Those Medicaid beneficiaries who are excluded from cost-sharing provisions include:
A)the blind.
B)the elderly.
C)pregnant women.
D)the disabled.

Accepted Answer

Pregnant women are excluded from Medicaid cost-sharing provisions to ensure they receive necessary prenatal and postnatal care without financial barriers.

Question 8

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.

Accepted Answer

Appeals of denied claims or claim adjustments must be filed within 180 days from the date of disposition.

Question 9

The federal government matches state expenditures for:
A)mandatory services.
B)state optional services.
C)administrative costs.
D)all of the above.

Accepted Answer

The federal government matches state expenditures for mandatory services, state optional services, and administrative costs, making all of the options correct. This matching is part of the structure of various federal-state partnership programs, such as Medicaid.

Question 10

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.

Accepted Answer

When an individual is covered by both Medicaid and Medicare, Medicare is always primary. Medicaid will fill in any gaps in coverage or pay for services not covered by Medicare.

Question 11

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."

Accepted Answer

The answer of In regard to Medicaid managed care, what...

Question 12

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.

Accepted Answer

The answer of To be considered for payment, Medicaid claims...

Question 13

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%.

Accepted Answer

The federal government reimburses states for the cost of services provided by Indian Health Service facilities at a rate of 100%. This is because these services are considered a federal responsibility, and the costs are fully covered by the federal government.

Question 14

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.

Accepted Answer

The answer of The
goal of Medicaid managed care is:
A)to increase...

Question 15

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.

Accepted Answer

When a Medicaid patient is on restricted status, it typically means they are required to receive services only from a specific provider. This is often part of a managed care plan or due to issues like overutilization of services.

Question 16

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.

Accepted Answer

PCCM stands for Primary Care Case Management, which refers to a type of Medicaid managed care plan in which a primary care physician is responsible for coordinating all necessary healthcare services for enrolled patients.

Question 17

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.

Accepted Answer

The two managed care models implemented in state Medicaid programs are HMOs and PCCM (Primary Care Case Management), not POS or PPOs. While POS (Point of Service) plans may be offered by Medicaid managed care organizations in some states, it is not a model implemented by the state Medicaid program itself. PCCM is a model in which primary care providers are responsible for coordinating and managing their patients' healthcare, while HMOs contract with healthcare providers and facilities to provide care for their members.

Question 18

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.

Accepted Answer

States may pay for Medicaid services through contracts with managed care organizations. This is a way to control costs and ensure that beneficiaries receive coordinated care. It involves paying a set amount per person per month to the managed care organization, which is responsible for providing all necessary services to the beneficiary. This type of payment system is becoming more common in Medicaid programs across the United States.

Question 19

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.

Accepted Answer

Medicaid eligibility should be verified at every visit to ensure that the patient is still eligible for coverage. This helps to prevent any potential issues with claims and ensures that the patient is receiving the appropriate coverage for their medical needs.

Question 20

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%

Accepted Answer

The Affordable Care Act of 2010 expanded Medicaid coverage to more low-income Americans, leading to an expected increase in Medicaid expenditures by 8% over earlier projections.

Quiz 14: Medicaid Medical Billing

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 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.

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.

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

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.

Those Medicaid beneficiaries who are excluded from cost-sharing provisions include: A)the blind. B)the elderly. C)pregnant women. D)the disabled.

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.

The federal government matches state expenditures for: A)mandatory services. B)state optional services. C)administrative costs. D)all of the above.

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.

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.

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%.

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.

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.

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.

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.

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.

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.

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%