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MIBC F12
A Fordney Ch 12
| Question | Answer |
|---|---|
| TEFRA stands for Tax Equity and Financial Reimbursement Act | False |
| The federal government designs the Medicaid program for each state based on the needs of the state | False |
| Medicaid is not so much an insurance program as an assistance program | True |
| Medicaid is an established program of medical assistance in 46 states | False |
| Medicaid is administered by federal funding only | False |
| The federal government determines the payment for medical services in the Medicaid program | False |
| Emergency care and pregnancy services are exempt by law from copayment requirements | True |
| The medicaid patient may be responsible for a copayment | True |
| The federal government financially supports the minimum assistance level of the medically needy aged, and the states must wholly support any part of the program that goes beyond the federal minimum | True |
| It is possible for a Medicaid patient to be on Medicaid 1 month and off Medicaid the following month | True |
| A physician may accept or refuse Medicaid patients on the basis of the individual patient and his or her circumstances | False |
| If a patient's Medicaid eligibility is checked when the patient is seen on February 1, the patient's eligibility need not be checked again if the patient is seen on February 28 | True |
| In some cases, the welfare office may grant retroactive eligibility to a patient | True |
| Family planning is a Medicaid basic benefit | True |
| Home health care is never covered under Medicaid | False |
| If a service is totally disallowed by Medicaid, a physician is within legal rights to bill the patient | True |
| All states Medicaid programs operate with a fee-for-service reimbursement system | False |
| Medicaid patients in managed care plans must go to hospitals participating in their assigned plan | True |
| The gatekeeper in a Medicaid managed care program is the specialist to whom the patient is referred | False |
| Managed care Medicaid programs usually save money in health care delivery | True |
| Prior approval or authorization is never required in the Medicaid program | False |
| All states that do not optically scan their claim forms must bill using the CMS-1500 claim form | True |
| When Medicaid and a third-party payer cover the patient, Medicaid is always the payer of last resort. | True |
| It is not possible for an alien to have Medicaid coverage | False |
| It is not possible for a person to be eligible for Medicaid benefits and also have additional group health insurance coverage | False |
| The Social Security Act of 1935 set up the public assistance programs | True |
| The Federal Emergency Relief Administration does not make funds available to pay for medical expenses of the needy unemployed | False |
| The Medicaid program was a direct result of a law passed by Congress in 1950 | True |
| In the Medicaid program, Congress authorized vendor payments for medical care, which are payments from the welfare agency directly to the physician | True |
| The medically needy aged do not require help in meeting costs of medical care | False |
| DEFRA and CHAP were responsible for expanding Medicaid eligibility requirements | True |
| Medicaid is administered by the state government with partial federal funding | True |
| The federal aspects of Medicaid are the responsibility of | CMS |
| The Omnibus Reconciliation Act | Provided assistance for the aged and disabled who are receiving Medicare and whose incomes are below the poverty level |
| Medicaid is available to needy and low-income people such as | The disabled, the blind and those age 65 years or older |
| Basic Maternal and Child Health Program (MCHP) provisions offered in all states include | Children with handicap needs who require orthopedic treatment or plastic surgery |
| If a physician accepts Medicaid patients, the physician must accept | The Medicaid-allowed amount |
| Medicaid eligibility must always be checked for the | Month of service and the type of service |
| The Medicaid service for prevention, early detection, and treatment for welfare children is known as | EPSDT |
| To control escalating health care costs by curbing unnecessary emergency department visits and emphasizing preventive care, Medicaid reform has involved | Managed care programs |
| Medicaid managed care patient claims should be sent to the | Managed care organization and not the medicaid fiscal agent |
| The time limit to appeal a claim varies from state to state, but it is usually | 30 to 60 days |
| The abbreviation for the Deficit Reduction Act of 1984 is | DEFRA |
| Medicaid was legally established by Title | XIX |
| The group of Medicaid recipients referred to as categorically needy includes | all cash recipients of the Aid to Families with Dependant Children, certain other AFDC-related groups, most cash recipients of the Supplemental Security Income program, and other SSI-relate groups |
| The two Medicaid eligibility classifications are | categorically needy group and the medically needy class |
| Some medicaid recipients in the medically needy category must pay a coinsurance payment and/or deductible, also known as a/an | share of cost within the eligibility month before state benefits may be received. |
| Medicaid identification cards are usually issued every | month |
| Time limits for Medicaid claim submission can vary from _ from the date of service depending on the state in which service was provided | two months to 1 year |
| Most states have __ for Medicaid payments if a patient requires medical care while out of state | reciprocity |
| The __ form, formerly known as an explanation of benefits form, accompanies all Medicaid payment checks | remitance advice |
Created by:
leemiller
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