Question 1

_____________ is where the healthcare provider bills and collects from liable third parties before sending the claim to Medicaid.

Accepted Answer

Cost avoidance

Question 2

Briefly explain the difference between the Medicare and Medicaid programs.

Accepted Answer

Medicare is healthcare insurance for disabled individuals,seniors 65 years of age and older,and any age person with end-stage renal disease (ESRD).It is federally controlled with uniform application across the country.To be eligible for Medicare,an individual must have contributed to the Medicare system (deductions from wages).Medicare pays for primary hospital care and related medically necessary physician services.There may be a copay provision,depending on the services received.
Medicaid is a needs-based healthcare program.Individuals must meet income and financial limitations to be eligible for certain programs.It pays for long-term care for qualifying individuals.Medicaid requires mandatory contribution of all the recipient's income in certain programs.Individual state-by-state plan options create a different program in each state.(They are generally similar but may be different in specific applications.)

Question 3

CMS defines quality as:

Accepted Answer

A)  free healthcare for every needy individual. 
B)  compulsory best practices. 
C)  preventive care for those who need it most. 
D)  the right care for every person every time. 
A)  free healthcare for every needy individual. 
B)  compulsory best practices. 
C)  preventive care for those who need it most. 
D)  the right care for every person every time. D

Question 4

The time limit for filing Medicaid claims varies from state to state but is typically _________.

Accepted Answer

The answer of The time limit for filing Medicaid claims...

Question 5

When one state allows Medicaid beneficiaries to be treated in an adjacent state,it is referred to as:

Accepted Answer

A)  illegal. 
B)  joint care. 
C)  reciprocity. 
D)  dual state eligibility. 
A)  illegal. 
B)  joint care. 
C)  reciprocity. 
D)  dual state eligibility.

Question 6

Medicaid payments are normally sent directly to the provider and "balance billing" is not allowed.

Accepted Answer

A) True 
 B)False

Question 7

Provisions of the Affordable Care Act expanded Medicaid to all Americans under age 65 whose family income was at or below 133% of the federal poverty level (FPL)beginning the year

Accepted Answer

A)  2010. 
B)  2012. 
C)  2013. 
D)  2014. 
A)  2010. 
B)  2012. 
C)  2013. 
D)  2014.

Question 8

When an individual is covered under both Medicaid and Medicare and/or a private healthcare policy,the payer of last resort is always:

Accepted Answer

A)  Medicare. 
B)  Medicaid. 
C)  Medigap. 
D)  the private insurer. 
A)  Medicare. 
B)  Medicaid. 
C)  Medigap. 
D)  the private insurer.

Question 9

The acronym for the program that provides comprehensive alternative care for noninstitutionalized elderly who otherwise would be in a nursing home is:

Accepted Answer

A)  PACE. 
B)  COBRA. 
C)  SCHIP. 
D)  EMTLA. 
A)  PACE. 
B)  COBRA. 
C)  SCHIP. 
D)  EMTLA.

Question 10

When a Medicaid beneficiary has no other healthcare coverage,the type of claim to be submitted is called a _____ claim.

Accepted Answer

A)  state 
B)  unilateral 
C)  functional 
D)  Medicaid simple 
A)  state 
B)  unilateral 
C)  functional 
D)  Medicaid simple

Question 11

Before providing services to patients claiming to be on Medicaid,the health insurance professional should:

Accepted Answer

A)  complete a claim. 
B)  verify eligibility. 
C)  check references. 
D)  ask for payment upfront. 
A)  complete a claim. 
B)  verify eligibility. 
C)  check references. 
D)  ask for payment upfront.

Question 12

What kind of a claim is generated when the beneficiary has two types of healthcare coverage?

Accepted Answer

A)  Medicaid simple claim 
B)  Medicare secondary claim 
C)  Medicaid secondary claim 
D)  Disproportionate share claim 
A)  Medicaid simple claim 
B)  Medicare secondary claim 
C)  Medicaid secondary claim 
D)  Disproportionate share claim

Question 13

Medicaid allows private individuals (or their families)to use their medical expenses to deplete their finances to the point where the individual or family becomes eligible for Medicaid assistance.This is called:

Accepted Answer

A)  spend down. 
B)  balance billing. 
C)  dual coverage. 
D)  income limiting. 
A)  spend down. 
B)  balance billing. 
C)  dual coverage. 
D)  income limiting.

Question 14

An individual who is eligible for SSI is not entitled to receive Social Security benefits.

Accepted Answer

A) True 
 B)False

Question 15

The optional services authorized by the Medicaid Act include:

Accepted Answer

A)  clinic services. 
B)  physical therapy. 
C)  dentures. 
D)  all of the above 
A)  clinic services. 
B)  physical therapy. 
C)  dentures. 
D)  all of the above

Question 16

As a general rule,Medicaid pays only for services that are determined to be:

Accepted Answer

A)  over $100. 
B)  experimental. 
C)  federally mandated. 
D)  medically necessary. 
A)  over $100. 
B)  experimental. 
C)  federally mandated. 
D)  medically necessary.

Question 17

Every time a Medicaid claim is submitted,a document called a remittance advice (RA)is generated.

Accepted Answer

A) True 
 B)False

Question 18

Under which federal act was the Medicaid program established?

Accepted Answer

Title XIX

Question 19

Under the DRA,the cost-share amount a state can charge an individual is based on his or her:

Accepted Answer

A)  age. 
B)  marital status. 
C)  income. 
D)  all of the above 
A)  age. 
B)  marital status. 
C)  income. 
D)  all of the above

Question 20

Medicaid programs have a fee-for-service coverage structure;there is no managed care option in any state.Medicaid is the largest source of funding for "safety-net" providers that serve the poor and uninsured.

Accepted Answer

A) True 
 B)False

_____________ is where the healthcare provider bills and collects from liable third parties before sending the claim to Medicaid.

Briefly explain the difference between the Medicare and Medicaid programs.

CMS defines quality as:

The time limit for filing Medicaid claims varies from state to state but is typically _________.

When one state allows Medicaid beneficiaries to be treated in an adjacent state,it is referred to as:

Medicaid payments are normally sent directly to the provider and "balance billing" is not allowed.

Provisions of the Affordable Care Act expanded Medicaid to all Americans under age 65 whose family income was at or below 133% of the federal poverty level (FPL)beginning the year

When an individual is covered under both Medicaid and Medicare and/or a private healthcare policy,the payer of last resort is always:

The acronym for the program that provides comprehensive alternative care for noninstitutionalized elderly who otherwise would be in a nursing home is:

When a Medicaid beneficiary has no other healthcare coverage,the type of claim to be submitted is called a _____ claim.

Before providing services to patients claiming to be on Medicaid,the health insurance professional should:

What kind of a claim is generated when the beneficiary has two types of healthcare coverage?

Medicaid allows private individuals (or their families)to use their medical expenses to deplete their finances to the point where the individual or family becomes eligible for Medicaid assistance.This is called:

An individual who is eligible for SSI is not entitled to receive Social Security benefits.

The optional services authorized by the Medicaid Act include:

As a general rule,Medicaid pays only for services that are determined to be:

Every time a Medicaid claim is submitted,a document called a remittance advice (RA)is generated.

Under which federal act was the Medicaid program established?

Under the DRA,the cost-share amount a state can charge an individual is based on his or her:

Medicaid programs have a fee-for-service coverage structure;there is no managed care option in any state.Medicaid is the largest source of funding for "safety-net" providers that serve the poor and uninsured.

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Types and Sources of Health Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Conquering Medicare’s Challenges

Military Carriers

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

Keys to Successful Claims Management

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

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Exam 8: Understanding Medicaid

_____________ is where the healthcare provider bills and collects from liable third parties before sending the claim to Medicaid.

Briefly explain the difference between the Medicare and Medicaid programs.

CMS defines quality as:

The time limit for filing Medicaid claims varies from state to state but is typically _________.

When one state allows Medicaid beneficiaries to be treated in an adjacent state,it is referred to as:

Medicaid payments are normally sent directly to the provider and "balance billing" is not allowed.

Provisions of the Affordable Care Act expanded Medicaid to all Americans under age 65 whose family income was at or below 133% of the federal poverty level (FPL)beginning the year

When an individual is covered under both Medicaid and Medicare and/or a private healthcare policy,the payer of last resort is always:

The acronym for the program that provides comprehensive alternative care for noninstitutionalized elderly who otherwise would be in a nursing home is:

When a Medicaid beneficiary has no other healthcare coverage,the type of claim to be submitted is called a _____ claim.

Before providing services to patients claiming to be on Medicaid,the health insurance professional should:

What kind of a claim is generated when the beneficiary has two types of healthcare coverage?

Medicaid allows private individuals (or their families)to use their medical expenses to deplete their finances to the point where the individual or family becomes eligible for Medicaid assistance.This is called:

An individual who is eligible for SSI is not entitled to receive Social Security benefits.

The optional services authorized by the Medicaid Act include:

As a general rule,Medicaid pays only for services that are determined to be:

Every time a Medicaid claim is submitted,a document called a remittance advice (RA)is generated.

Under which federal act was the Medicaid program established?

Under the DRA,the cost-share amount a state can charge an individual is based on his or her:

Medicaid programs have a fee-for-service coverage structure;there is no managed care option in any state.Medicaid is the largest source of funding for "safety-net" providers that serve the poor and uninsured.

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Types and Sources of Health Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Conquering Medicare’s Challenges

Military Carriers

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

Keys to Successful Claims Management

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

Filters