Ch 8: Review Test

Question 1

The XIX of the Social Security Act of 1965 established what?

Answer 1

Medicaid

Question 2

Medicaid is administered by who?

Answer 2

The Centers for Medicare and Medicaid Services (CMS)

Question 3

All Americans younger than 65 with income at or lower than 133% of the Federal Poverty Level (FPL) were eligible for Medicaid beginning in what year?

Answer 3

2014

Question 4

SSI is a cash benefit program controlled by who?

Answer 4

The Social Security Administration

Question 5

Categorically needy individuals typically include what three groups of people?

Answer 5

• Individuals receiving SSI
• Pregnant women and children
• Low income families

Question 6

What is the term used for the process of depleting private or family finances to the point at which the individual or family becomes eligible for Medicaid assistance?

Answer 6

Spend down

Question 7

What are the three optional services states can choose to provide to recipients of its Medicaid program?

Answer 7

• Clinic services
• Physical and occupational therapy
• Dentures

Question 8

A state option that provides individuals with disabilities who are eligible for nursing homes and other institutional settings with options to receive community-based services is called ____?

Answer 8

Community First Choice Option

Question 9

Nearly all Medicaid contractors accept which two types of claims?

Answer 9

• Paper Claims

- Electronic Claims

Question 10

What program provides comprehensive alternative care for non-institutionalized elderly who otherwise would be in a nursing home?

Answer 10

PACE

Question 11

An organization that Medicaid state programs typically contracts with that administer government healthcare programs, including claims processing, is called a ____?

Answer 11

Medical contractor

Question 12

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

Answer 12

Medically necessary

Question 13

How often should Medicaid coverage be verified?

Answer 13

At least once a month

Question 14

Providers can reduce the number of denied claims by utilizing what?

Answer 14

Eligibility verification systems

Question 15

Aged or disabled individuals who are very poor are covered under the Medicaid and Medicare programs, commonly referred to as ____?

Answer 15

• Dual eligibles

- Medi-Medi

Question 16

All Medicare Savings Programs (MSPs), also known as Medicare buy-in programs, save the Medicare beneficiary money by paying for what?

Answer 16

Part B premium

Question 17

What kind of claim is generated when the beneficiary has a second type of healthcare coverage?

Answer 17

A Medicaid secondary claim

Question 18

When one state allows Medicaid beneficiaries from other states to be treated in its medical facilities, this exchange of privileges is referred to as what?

Answer 18

Reciprocity

Question 19

Every time a claim is sent to Medicaid, a document is generated explaining how the claim was adjudicated or how the payment was determined, which is called a ____?

Answer 19

Remittance advice

Question 20

What is it called when a healthcare provider engages in intentional misrepresentation or deception that could result in an unauthorized benefit to an individual?

Answer 20

Fraud