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AR Chapter 13
Medicaid
| Question | Answer |
|---|---|
| medicaid is administered by: | state government with partial federal funding - providing assistance to low income individuals and familie |
| medicaid eligibility | certain needy and low income people such as: elderly, blind, disabled, and families with children. only available to US citizens. patients can be eligible one month and not the next. |
| categorically needy | care provided to families, pregnant women, aged, disabled and persons receiving institutional of long term care |
| medically needy | general assistance for medically indigent and low income and low income losing employer health coverage. coinsurance, deductible amount must be met with in the eligible month before they can receive state benefits |
| EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) | program of prevention, early detection, and treatment of welfare children who are younger than 21 |
| blocks on the claim form | has the least number of mandatory blocks to be completed on the CMS claim form |
| medicaid fraud | each state has a fraud control unit - it is a federally funded state law enforcement entity, that investigates and prosecutes cases of fraud and other violations |
| bill medicade when patient has private insurance | secondary, always the payer of last resort |
| able to bill a patient when a waiver of liability signed | yes, as long as you have informed the patient and they have signed the wavier |
| 3 programs medicaid offers patients over 65: | 1)MQMB (Medicare Qualified Medicare Beneficiaries) 2)SLMBs (Specified Low Income Medicare Beneficiares) 3)QI (Qualifying Individuals) |
| 3 categorically needy groups: | 1)families and pregnant women, 2)aged and disabled, 3)institutional or long term care |
| 2 co payment types | 1)fixed copay - pay at the time service is provided, and 2) share of cost/spend down - this must copayment must be met each month before medicaid pays |
| condition for a MCHP (Maternal and Child Health Program) to qualify: | 1) cerebral palsy, 2)clubfoot, and 3)cleft lip |
| who is responsible for the guidelines of medicaid | CMS (Centers for Medicare and Medicaid Services) |
| reciprocity | applies when the patient obtains services while out of state in which he or she receives benefits - contact the medicaid intermediary in the home state and complete appropriate form - reimbursement is at the home states rate |
| what year did congress mandate all states set up a program of assistance | 1950 |
| can a physician refuse to treat a medicaid patient | yes, may accept or refuse patients, but decision is based on medicaid program and not the patients situation |
| capitated | monies are paid on a monthly basis |
| fee for service | money is reimbursed for every service that is performed |
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