Question 1

If a patient lives on the state border of Florida and sees a physician in Georgia, to whom should the provider send the claim?

Accepted Answer

A)  Medicaid central processing 
B)  Georgia 
C)  Florida 
D)  either Georgia or Florida 
A)  Medicaid central processing 
B)  Georgia 
C)  Florida 
D)  either Georgia or Florida C

Question 2

In addition to deductibles, what might a Medicaid recipient in the medically needy classification need to pay for medical services?

Accepted Answer

A)  copay 
B)  coinsurance 
C)  fee-for-service 
D)  nothing 
A)  copay 
B)  coinsurance 
C)  fee-for-service 
D)  nothing B

Question 3

Under Medicaid, when can physicians bill patients for the difference between the Medicaid payment and their normal charge?

Accepted Answer

A)  under any circumstances 
B)  under the appropriate circumstances 
C)  under no circumstances 
D)  under extenuating circumstances 
A)  under any circumstances 
B)  under the appropriate circumstances 
C)  under no circumstances 
D)  under extenuating circumstances C

Question 4

Which type of program best describes the Medicaid program?

Accepted Answer

A)  insurance program 
B)  discount plan 
C)  assistance program 
D)  charity care 
A)  insurance program 
B)  discount plan 
C)  assistance program 
D)  charity care

Question 5

Which guidelines do participating providers abide by for a managed care plan of Medicaid?

Accepted Answer

A)  managed care organization 
B)  state Medicaid regulations 
C)  both managed care organization and federal requirements 
D)  neither managed care organization nor state Medicaid regulations 
A)  managed care organization 
B)  state Medicaid regulations 
C)  both managed care organization and federal requirements 
D)  neither managed care organization nor state Medicaid regulations

Question 6

Why might it be difficult for Medicaid patients to a find a physician who will treat them?

Accepted Answer

A)  lower fee structure 
B)  restricted network 
C)  difficult credentialing process 
D)  confusing system 
A)  lower fee structure 
B)  restricted network 
C)  difficult credentialing process 
D)  confusing system

Question 7

Which is the electronic claim format accepted by Medicaid?

Accepted Answer

A)  HIPAA 837 
B)  CMS-1500 
C)  both HIPAA 837 and CMS-1500 
D)  neither HIPAA 837 nor CMS-1500 
A)  HIPAA 837 
B)  CMS-1500 
C)  both HIPAA 837 and CMS-1500 
D)  neither HIPAA 837 nor CMS-1500

Question 8

Which program is committed to fighting fraud and abuse in Medicaid?

Accepted Answer

A)  state fiscal agent 
B)  Centers for Medicare and Medicaid Services 
C)  Medicaid Alliance for Program Safeguards 
D)  Department of Justice 
A)  state fiscal agent 
B)  Centers for Medicare and Medicaid Services 
C)  Medicaid Alliance for Program Safeguards 
D)  Department of Justice

Question 9

The obligation of a government program or insurance plan to pay all or part of a patient's medical costs is known as

Accepted Answer

A)  fiscal responsibility 
B)  third-party liability 
C)  preauthorization 
D)  None of these 
A)  fiscal responsibility 
B)  third-party liability 
C)  preauthorization 
D)  None of these

Question 10

What is necessary for payment of emergency care?

Accepted Answer

A)  referral number 
B)  Service Authorization Exception Code 
C)  preauthorization code 
D)  emergency care is covered with authorization 
A)  referral number 
B)  Service Authorization Exception Code 
C)  preauthorization code 
D)  emergency care is covered with authorization

Question 11

Under Medicaid, states offer

Accepted Answer

A)  fee-for-service plans 
B)  managed care plans 
C)  both fee-for-service plans and managed care plans 
D)  neither fee-for-service plans nor managed care plans 
A)  fee-for-service plans 
B)  managed care plans 
C)  both fee-for-service plans and managed care plans 
D)  neither fee-for-service plans nor managed care plans

Question 12

In order to lower costs, which service might be subject to a reduction in payment?

Accepted Answer

A)  mental health services 
B)  prescription drugs 
C)  prosthetic devices 
D)  nursing homes 
A)  mental health services 
B)  prescription drugs 
C)  prosthetic devices 
D)  nursing homes

Question 13

What is not covered by Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)?

Accepted Answer

A)  sickle cell trait and disease 
B)  mental evaluations 
C)  lead absorption 
D)  dental problems 
A)  sickle cell trait and disease 
B)  mental evaluations 
C)  lead absorption 
D)  dental problems

Question 14

An organization that processes claims for a government program is called a

Accepted Answer

A)  fiscal agent 
B)  payer of last resort 
C)  processing agent 
D)  both fiscal agent and processing agent 
A)  fiscal agent 
B)  payer of last resort 
C)  processing agent 
D)  both fiscal agent and processing agent

Question 15

By law, Medicaid is known as the payer of

Accepted Answer

A)  primary insurance 
B)  secondary insurance 
C)  Welfare participants 
D)  last resort 
A)  primary insurance 
B)  secondary insurance 
C)  Welfare participants 
D)  last resort

Question 16

Medicaid recipients with very low or no incomes are known as

Accepted Answer

A)  categorically needy 
B)  medically needy 
C)  fiscal agents 
D)  None of these 
A)  categorically needy 
B)  medically needy 
C)  fiscal agents 
D)  None of these

Question 17

Where are Medicaid managed care claims sent?

Accepted Answer

A)  state fiscal agent 
B)  managed care plan 
C)  state Medicaid department 
D)  federal government 
A)  state fiscal agent 
B)  managed care plan 
C)  state Medicaid department 
D)  federal government

Question 18

What are some of the benefits cuts of Medicaid that have taken place due to budget?

Accepted Answer

A)  family planning 
B)  routine visits 
C)  prescription drugs 
D)  family planning and routine visits 
A)  family planning 
B)  routine visits 
C)  prescription drugs 
D)  family planning and routine visits

Question 19

Ticarey is a child who has sickle cell anemia. His father is disabled, but works enough to provide for day-to-day expenses excluding healthcare. Under which act/plan is Ticarey eligible for coverage?

Accepted Answer

A)  EPSDT 
B)  TWWIIA 
C)  TANF 
D)  EMEVS 
A)  EPSDT 
B)  TWWIIA 
C)  TANF 
D)  EMEVS

Question 20

Under what type of Medicaid plan may thepatients be treated by the provider of their choice, as long as that provider accepts Medicaid?

Accepted Answer

A)  fee-for-service 
B)  managed care plans 
C)  capitation 
D)  point-of-service 
A)  fee-for-service 
B)  managed care plans 
C)  capitation 
D)  point-of-service

If a patient lives on the state border of Florida and sees a physician in Georgia, to whom should the provider send the claim?

In addition to deductibles, what might a Medicaid recipient in the medically needy classification need to pay for medical services?

Under Medicaid, when can physicians bill patients for the difference between the Medicaid payment and their normal charge?

Which type of program best describes the Medicaid program?

Which guidelines do participating providers abide by for a managed care plan of Medicaid?

Why might it be difficult for Medicaid patients to a find a physician who will treat them?

Which is the electronic claim format accepted by Medicaid?

Which program is committed to fighting fraud and abuse in Medicaid?

The obligation of a government program or insurance plan to pay all or part of a patient's medical costs is known as

What is necessary for payment of emergency care?

Under Medicaid, states offer

In order to lower costs, which service might be subject to a reduction in payment?

What is not covered by Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)?

An organization that processes claims for a government program is called a

By law, Medicaid is known as the payer of

Medicaid recipients with very low or no incomes are known as

Where are Medicaid managed care claims sent?

What are some of the benefits cuts of Medicaid that have taken place due to budget?

Ticarey is a child who has sickle cell anemia. His father is disabled, but works enough to provide for day-to-day expenses excluding healthcare. Under which act/plan is Ticarey eligible for coverage?

Under what type of Medicaid plan may thepatients be treated by the provider of their choice, as long as that provider accepts Medicaid?

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Patient Encounters and Billing Information

Diagnostic Coding

Procedural Coding

Payment Methods and Checkout Procedures

Health Care Claim Preparation and Transmission

Private Payersblue Cross and Blue Shield

Medicare

Tricare and Champva

Workers Compensation and Automobiledisability Insurance

Claim Processing, Payments, and Collections

Hospital Insurance

Filters

Exam 10: Medicaid

If a patient lives on the state border of Florida and sees a physician in Georgia, to whom should the provider send the claim?

In addition to deductibles, what might a Medicaid recipient in the medically needy classification need to pay for medical services?

Under Medicaid, when can physicians bill patients for the difference between the Medicaid payment and their normal charge?

Which type of program best describes the Medicaid program?

Which guidelines do participating providers abide by for a managed care plan of Medicaid?

Why might it be difficult for Medicaid patients to a find a physician who will treat them?

Which is the electronic claim format accepted by Medicaid?

Which program is committed to fighting fraud and abuse in Medicaid?

The obligation of a government program or insurance plan to pay all or part of a patient's medical costs is known as

What is necessary for payment of emergency care?

Under Medicaid, states offer

In order to lower costs, which service might be subject to a reduction in payment?

What is not covered by Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)?

An organization that processes claims for a government program is called a

By law, Medicaid is known as the payer of

Medicaid recipients with very low or no incomes are known as

Where are Medicaid managed care claims sent?

What are some of the benefits cuts of Medicaid that have taken place due to budget?

Ticarey is a child who has sickle cell anemia. His father is disabled, but works enough to provide for day-to-day expenses excluding healthcare. Under which act/plan is Ticarey eligible for coverage?

Under what type of Medicaid plan may thepatients be treated by the provider of their choice, as long as that provider accepts Medicaid?

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Patient Encounters and Billing Information

Diagnostic Coding

Procedural Coding

Payment Methods and Checkout Procedures

Health Care Claim Preparation and Transmission

Private Payersblue Cross and Blue Shield

Medicare

Tricare and Champva

Workers Compensation and Automobiledisability Insurance

Claim Processing, Payments, and Collections

Hospital Insurance

Filters