Understanding Health Insurance 11e Chapter 15 Review

Any provider who accepts a Medicaid patient must accept the Medicaid-determined payment as:

payment in full.

_____ services consist of routine pediatric checkups provided to all children enrolled in Medicaid.

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)

Medicaid preauthorization services include:

- Elective inpatient admission - Emergency inpatient admission - More than one preoperative day - Outpatient procedure(s) to be performed in an inpatient setting

Medicaid eligibility is limited to individuals who can be classified in the three eligibility groups:

-categorically needy -medically needy -special groups.

What type(s) of services are exempt from copayments from Medicaid recipients?

-emergency services -family planning

When a patient is dual eligible, what services does Medicaid pay for beyond Medicare's covered services?

-nursing facility care -prescription drugs -eyeglasses -hearing aids

When a patient has coverage through another carrier and Medicaid, Medicaid is always either the:

-secondary -payer of last resort

The federal government reimburses states for ____ of the cost of services provided through facilities of the Indian Health Service.

100%

The Medicaid program (Title 19 of the Social Security Act) was implemented in which year?

1965

TANF was previously known as:

Aid to Families with Dependent Children

The portion of the Medicaid program paid by the federal government is known as the:

Federal Medical Assistance Percentage.

How long are the claims for an infant filed under the mother's Medicaid identification number?

First 10 days of life.

What would cause an individual to be eligible for Medicaid one month and not the next?

Income

What is California's equivalent to the Medicaid program?

MediCal

Once a person qualifies for Medicaid, when will their eligibility be subject to change?

Monthly

What is the timely filing for a Medicare-Medicaid Crossover claim?

One year from the date of service

What does the acronym TANF stand for?

Temporary Assistance for Needy Families

What is the timely filing for a Medicaid claim?

Varies from state-to-state

Is an infant of a Medicaid Recipient automatically eligible under Medicaid?

Yes - one year

Medicaid is jointly funded by the ____ and ____ governments to assist states in providing adequate medical care to qualified individuals.

federal, state

Dual eligibles refer to:

individuals entitled to Medicare and eligible for some type of Medicaid benefit.

Categorically needy Medicaid eligibility groups are not necessarily entitled to:

nursing facility services for individuals under the age of 21

The primary purpose of the _____ is to safeguard against unnecessary or inappropriate use of Medicaid services or excess payments and assess the quality of those services.

surveillance and utilization review system (SURS)

Medicaid operates as a(n) ____ payment system.

vendor-payment program: 1. fee-for-service basis 2. prepayment arrangements