Question 1

The legal obligation of other insuring entities to pay all or part of the healthcare expenses of a Medicaid beneficiary is called:

Accepted Answer

A)  pay or chase. 
B)  third-party liability. 
C)  payer of last resort. 
D)  reciprocity. 
A)  pay or chase. 
B)  third-party liability. 
C)  payer of last resort. 
D)  reciprocity.

Question 2

The legal obligation of other insurance policies/programs to pay all or part of the expenditures for medical assistance furnished under a state plan is referred to as ____________________.

Accepted Answer

third-part

Question 3

Full-benefit dual-eligible individuals receive prescription drug coverage through their state Medicaid programs.

Accepted Answer

A) True 
 B)False

Question 4

To qualify for supplemental security income (SSI),individuals must meet certain financial guidelines set by:

Accepted Answer

A)  the U.S. Constitution. 
B)  individual state laws. 
C)  the federal poverty level (FPL). 
D)  the Centers for Medicare and Medicaid Services (CMS). 
A)  the U.S. Constitution. 
B)  individual state laws. 
C)  the federal poverty level (FPL). 
D)  the Centers for Medicare and Medicaid Services (CMS).

Question 5

States must cover categorically needy individuals,but they have options as to how to define "categorically needy."

Accepted Answer

A) True 
 B)False

Question 6

In order for federal matching funds in a state's Medicaid program to be received,Title XIX of the Social Security Act requires that states offer certain basic services called:

Accepted Answer

A)  monitoring. 
B)  service matching. 
C)  mandated services. 
D)  Medicaid equalization. 
A)  monitoring. 
B)  service matching. 
C)  mandated services. 
D)  Medicaid equalization.

Question 7

List the qualifications one must have to qualify for SSI.

Accepted Answer

Be at least 65 years old or blind or dis

Question 8

The health insurance professional should check with the Medicaid contractor in his or her state for the _____________ deadline.

Accepted Answer

The answer of The health insurance professional should check with...

Question 9

A commercial insurer contracted by the Department of Health and Human Services (HHS)for the purpose of processing and administering Medicaid claims is a:

Accepted Answer

A)  claims contractor. 
B)  Medicaid contractor. 
C)  commercial advisor. 
D)  Medicaid administrator. 
A)  claims contractor. 
B)  Medicaid contractor. 
C)  commercial advisor. 
D)  Medicaid administrator.

Question 10

There is a Medicaid program in all 50 states,the District of Columbia,and U.S.territories.

Accepted Answer

A) True 
 B)False

Question 11

Groups exempt from paying premiums and cost sharing include all,except:

Accepted Answer

A)  pregnant women. 
B)  those admitted to hospitals. 
C)  children. 
D)  those in hospice. 
A)  pregnant women. 
B)  those admitted to hospitals. 
C)  children. 
D)  those in hospice.

Question 12

Some Medicaid services require:

Accepted Answer

A)  a copayment. 
B)  prior approval. 
C)  preauthorization. 
D)  all are correct 
A)  a copayment. 
B)  prior approval. 
C)  preauthorization. 
D)  all are correct

Question 13

Write a brief summary of the development and structure of Medicaid

Accepted Answer

(from the textbook)
Medicaid originally

Question 14

When a healthcare provider engages in intentional misrepresentation or deception that could result in an unauthorized benefit to an individual,it is called:

Accepted Answer

A)  fraud. 
B)  abuse. 
C)  negligence. 
D)  malpractice. 
A)  fraud. 
B)  abuse. 
C)  negligence. 
D)  malpractice.

Question 15

Medicaid recipients who qualify for benefits in January will qualify for the remainder of the year.

Accepted Answer

A) True 
 B)False

Question 16

An individual who is eligible for both Medicare and Medicaid programs is said to be a/an:

Accepted Answer

A)  dual eligible. 
B)  dual qualifier. 
C)  elderly qualifier. 
D)  tax exempt aged. 
A)  dual eligible. 
B)  dual qualifier. 
C)  elderly qualifier. 
D)  tax exempt aged.

Question 17

The Medicaid program,referred to in the past as Aid to Families with Dependent Children (AFDC),is now called:

Accepted Answer

Temporary

Question 18

Identify which of the following typically does not fall under the "mandatory" services that must be offered to categorically needy Medicaid beneficiaries.

Accepted Answer

A)  Inpatient hospital services 
B)  Physician services 
C)  Optometrist services and eyeglasses 
D)  Laboratory and x-ray services 
A)  Inpatient hospital services 
B)  Physician services 
C)  Optometrist services and eyeglasses 
D)  Laboratory and x-ray services

Question 19

States may combine the administration of Medicaid with other programs,such as CHIP.

Accepted Answer

A) True 
 B)False

Question 20

The ____________ program provides comprehensive alternative care for non-institutionalized elderly who otherwise would be in a nursing home.

Accepted Answer

Program of All-Inclusive Care

The legal obligation of other insuring entities to pay all or part of the healthcare expenses of a Medicaid beneficiary is called:

The legal obligation of other insurance policies/programs to pay all or part of the expenditures for medical assistance furnished under a state plan is referred to as ____________________.

Full-benefit dual-eligible individuals receive prescription drug coverage through their state Medicaid programs.

To qualify for supplemental security income (SSI),individuals must meet certain financial guidelines set by:

States must cover categorically needy individuals,but they have options as to how to define "categorically needy."

In order for federal matching funds in a state's Medicaid program to be received,Title XIX of the Social Security Act requires that states offer certain basic services called:

List the qualifications one must have to qualify for SSI.

The health insurance professional should check with the Medicaid contractor in his or her state for the _____________ deadline.

A commercial insurer contracted by the Department of Health and Human Services (HHS)for the purpose of processing and administering Medicaid claims is a:

There is a Medicaid program in all 50 states,the District of Columbia,and U.S.territories.

Groups exempt from paying premiums and cost sharing include all,except:

Some Medicaid services require:

Write a brief summary of the development and structure of Medicaid

When a healthcare provider engages in intentional misrepresentation or deception that could result in an unauthorized benefit to an individual,it is called:

Medicaid recipients who qualify for benefits in January will qualify for the remainder of the year.

An individual who is eligible for both Medicare and Medicaid programs is said to be a/an:

The Medicaid program,referred to in the past as Aid to Families with Dependent Children (AFDC),is now called:

Identify which of the following typically does not fall under the "mandatory" services that must be offered to categorically needy Medicaid beneficiaries.

States may combine the administration of Medicaid with other programs,such as CHIP.

The ____________ program provides comprehensive alternative care for non-institutionalized elderly who otherwise would be in a nursing home.

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

Exam 8: Understanding Medicaid

The legal obligation of other insuring entities to pay all or part of the healthcare expenses of a Medicaid beneficiary is called:

The legal obligation of other insurance policies/programs to pay all or part of the expenditures for medical assistance furnished under a state plan is referred to as ____________________.

Full-benefit dual-eligible individuals receive prescription drug coverage through their state Medicaid programs.

To qualify for supplemental security income (SSI),individuals must meet certain financial guidelines set by:

States must cover categorically needy individuals,but they have options as to how to define "categorically needy."

In order for federal matching funds in a state's Medicaid program to be received,Title XIX of the Social Security Act requires that states offer certain basic services called:

List the qualifications one must have to qualify for SSI.

The health insurance professional should check with the Medicaid contractor in his or her state for the _____________ deadline.

A commercial insurer contracted by the Department of Health and Human Services (HHS)for the purpose of processing and administering Medicaid claims is a:

There is a Medicaid program in all 50 states,the District of Columbia,and U.S.territories.

Groups exempt from paying premiums and cost sharing include all,except:

Some Medicaid services require:

Write a brief summary of the development and structure of Medicaid

When a healthcare provider engages in intentional misrepresentation or deception that could result in an unauthorized benefit to an individual,it is called:

Medicaid recipients who qualify for benefits in January will qualify for the remainder of the year.

An individual who is eligible for both Medicare and Medicaid programs is said to be a/an:

The Medicaid program,referred to in the past as Aid to Families with Dependent Children (AFDC),is now called:

Identify which of the following typically does not fall under the "mandatory" services that must be offered to categorically needy Medicaid beneficiaries.

States may combine the administration of Medicaid with other programs,such as CHIP.

The ____________ program provides comprehensive alternative care for non-institutionalized elderly who otherwise would be in a nursing home.

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