B&C Chapter 15: Medicaid Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

adjusted claim

A

payment correction resulting in additional payment(s) to the provider.

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2
Q

dual eligibles

A

individuals entitled to Medicare and eligible for some type of Medicaid benefit.

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3
Q

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services

A

legislation that mandates states to provide routine pediatric checkups to all children enrolled in Medicaid.

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4
Q

Federal Medical Assistance Percentage

A

portion of the Medicaid program paid by the federal government.

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5
Q

federal poverty level (FPL)

A

income guidelines established annually by the federal government.

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6
Q

Medicaid eligibility verification system (MEVS)

A

sometimes called recipient eligibility verification system or REVS; allows providers to electronically access the state’s eligibility file through point-of-sale device, computer software, and automated voice response.

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7
Q

Medicaid remittance advice

A

sent to the provider; serves as an explanation of benefits from Medicaid and contains the current status of all claims.

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8
Q

medical assistance program

A

program for individuals with incomes below the federal poverty level.

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9
Q

mother/baby claim

A

submitted for services provided to a baby under the mother’s Medicaid identification number.

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10
Q

recipient eligibility verification system (REVS)

A

allows providers to electronically access the state’s eligibility file through point-of-sale device, computer software, and automated voice response.

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11
Q

surveillance and utilization review subsystem (SURS)

A

safeguards against unnecessary or inappropriate use of Medicaid services or excess payments and assesses the quality of those services.

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12
Q

Temporary Assistance for Needy Families

A

makes cash assistance available on a time-limited basis for children deprived of support because of a parent’s death, incapacity, absence, or unemployment.

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13
Q

voided claim

A

claim Medicaid should not have originally paid, resulting in a deduction from the lump-sum payment made to the provider.

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