Question 1

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

Accepted Answer

Eligibility for Medicaid varies by state and each state has its own eligibility criteria, so a person eligible for Medicaid in one state may not necessarily be eligible in another state. However, some individuals may qualify for Medicaid coverage under certain circumstances when they move to a different state.

Question 2

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

Accepted Answer

While some Medicaid plans may require cost-sharing measures such as copays or deductibles, most do not require beneficiaries to pay a premium.

Question 3

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.

Accepted Answer

The answer of The code ST used in form locator...

Question 4

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.

Accepted Answer

The answer of The code S2 used in form locator...

Question 5

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).

Accepted Answer

The answer of When reporting National Drug Code (NDC) units...

Question 6

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.

Accepted Answer

The Welfare Reform Bill of 1996 established a 5-year waiting period for legal resident aliens who entered the United States after August 22, 1996, to be eligible for Medicaid, with some exceptions. Therefore, legal resident aliens who entered the US after 1996 are not eligible for Medicaid for 5 years.

Question 7

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.

Accepted Answer

The answer of Physician services claims are filed using the:
A)UB-04...

Question 8

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

Accepted Answer

Physicians cannot bill Medicaid patients for services if prior authorization was not obtained. Medicaid regulations prohibit balance billing patients for services that were not authorized by Medicaid.

Question 9

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.

Accepted Answer

The answer of For a dependent 6-year-old child, form locator...

Question 10

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

Accepted Answer

PACE providers are designed to provide comprehensive, individualized care to older adults who meet the criteria for nursing home care, but wish to live in the community. PACE providers agree to make all services available to beneficiaries without any cost-sharing requirements.

Question 11

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

Accepted Answer

Hospitals can submit interim claims for Medicaid patients while they are still hospitalized, especially for long-stay patients, as part of Medicaid's billing regulations to ensure continuous funding and operational flow.

Question 12

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)

Accepted Answer

The answer of What document is issued to a Medicaid...

Question 13

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.

Accepted Answer

The answer of When filing a claim for a newborn...

Question 14

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

Accepted Answer

According to federal Medicaid rules, states that choose to have a medically needy program must include coverage for pregnant women.

Question 15

State legislators cannot make changes in Medicaid eligibility or services.

Accepted Answer

State legislators have the authority to make changes in Medicaid eligibility or services within their respective states through the state plan amendment process. However, certain changes may require approval from the federal government.

Question 16

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.

Accepted Answer

The answer of For supplemental information entered in form locator...

Question 17

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

Accepted Answer

This is a requirement for providers participating in Medicaid. They cannot bill the patient for any amount beyond the Medicaid payment rate.

Question 18

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.

Accepted Answer

The answer of How is form locator 10d: Reserved for...

Question 19

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.

Accepted Answer

The answer of Types of supplemental information that can be...

Question 20

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

Accepted Answer

The answer of States determine the amount and duration of...

Quiz 14: Medicaid Medical Billing

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

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

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.

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.

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).

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.

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.

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

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.

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

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

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)

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.

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

State legislators cannot make changes in Medicaid eligibility or services.

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.

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

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.

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.

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