B&C Chapter 15: Medicaid Flashcards
adjusted claim
payment correction resulting in additional payment(s) to the provider.
dual eligibles
individuals entitled to Medicare and eligible for some type of Medicaid benefit.
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services
legislation that mandates states to provide routine pediatric checkups to all children enrolled in Medicaid.
Federal Medical Assistance Percentage
portion of the Medicaid program paid by the federal government.
federal poverty level (FPL)
income guidelines established annually by the federal government.
Medicaid eligibility verification system (MEVS)
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.
Medicaid remittance advice
sent to the provider; serves as an explanation of benefits from Medicaid and contains the current status of all claims.
medical assistance program
program for individuals with incomes below the federal poverty level.
mother/baby claim
submitted for services provided to a baby under the mother’s Medicaid identification number.
recipient eligibility verification system (REVS)
allows providers to electronically access the state’s eligibility file through point-of-sale device, computer software, and automated voice response.
surveillance and utilization review subsystem (SURS)
safeguards against unnecessary or inappropriate use of Medicaid services or excess payments and assesses the quality of those services.
Temporary Assistance for Needy Families
makes cash assistance available on a time-limited basis for children deprived of support because of a parent’s death, incapacity, absence, or unemployment.
voided claim
claim Medicaid should not have originally paid, resulting in a deduction from the lump-sum payment made to the provider.
