Ch 8: Review Test Flashcards
Understanding Medicaid
The XIX of the Social Security Act of 1965 established what?
Medicaid
Medicaid is administered by who?
The Centers for Medicare and Medicaid Services (CMS)
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?
2014
SSI is a cash benefit program controlled by who?
The Social Security Administration
Categorically needy individuals typically include what three groups of people?
- Individuals receiving SSI
- Pregnant women and children
- Low income families
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?
Spend down
What are the three optional services states can choose to provide to recipients of its Medicaid program?
- Clinic services
- Physical and occupational therapy
- Dentures
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 ____?
Community First Choice Option
Nearly all Medicaid contractors accept which two types of claims?
- Paper Claims
- Electronic Claims
What program provides comprehensive alternative care for non-institutionalized elderly who otherwise would be in a nursing home?
PACE
An organization that Medicaid state programs typically contracts with that administer government healthcare programs, including claims processing, is called a ____?
Medical contractor
As a general rule, Medicaid only pays for services that are determined to be ____?
Medically necessary
How often should Medicaid coverage be verified?
At least once a month
Providers can reduce the number of denied claims by utilizing what?
Eligibility verification systems
Aged or disabled individuals who are very poor are covered under the Medicaid and Medicare programs, commonly referred to as ____?
- Dual eligibles
- Medi-Medi
All Medicare Savings Programs (MSPs), also known as Medicare buy-in programs, save the Medicare beneficiary money by paying for what?
Part B premium
What kind of claim is generated when the beneficiary has a second type of healthcare coverage?
A Medicaid secondary claim
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?
Reciprocity
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 ____?
Remittance advice
What is it called when a healthcare provider engages in intentional misrepresentation or deception that could result in an unauthorized benefit to an individual?
Fraud
