Medicaid Basics
What is the primary purpose of Medicaid?
Answer: Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families.
What is the ICD-10 code for hypertension, stage 1?
Answer: I10
What does "risk adjustment" mean in the context of Medicaid?
Answer: Risk adjustment adjusts payments to health plans based on the health status of enrollees, ensuring plans are fairly compensated for the cost of care for higher-risk populations.
What is the role of accurate documentation in Medicaid coding?
Answer: Accurate documentation ensures that codes reflect the patient's actual conditions, supporting proper reimbursement and reducing the risk of audits.
Which of the following is a special Medicaid population: A) Seniors, B) Pregnant women, C) Both A and B?
Answer: C) Both A and B
Which of the following is NOT eligible for Medicaid: A) Pregnant women, B) Children under 18, C) College students with private insurance?
Answer: C) College students with private insurance
What is the ICD-10 code for type 2 diabetes without complications?
Answer: E11.9
Which of the following conditions are considered high-risk in Medicaid risk adjustment: A) Diabetes, B) Asthma, C) Hypertension?
Answer: A) Diabetes
True or False: It is acceptable to code a condition that is not documented in the patient's medical record for Medicaid billing.
Answer: False. All diagnoses must be documented in the patient's medical record.
What is the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit in Medicaid?
Answer: EPSDT is a Medicaid benefit that ensures children under 21 receive all necessary screening, diagnostic, and treatment services.
True or False: Medicaid is a federal program, and the rules are the same in every state.
Answer: False. Medicaid is administered by both the federal government and states, and eligibility and benefits vary by state.
Which ICD-10 code would you assign for asthma, uncomplicated?
J45.909
What are HCC codes (Hierarchical Condition Categories), and why are they important for Medicaid?
Answer: HCC codes are used to capture the health status of Medicaid enrollees, affecting the health plan's reimbursement based on the risk of their population.
What should a coder do if they find a diagnosis in the medical record that is not coded?
Answer: The coder should add the diagnosis to the claim if it meets Medicaid guidelines and is supported by the documentation.
What is the purpose of Medicaid for dual-eligible beneficiaries (those eligible for both Medicaid and Medicare)?
Answer: To provide healthcare coverage to low-income individuals who are eligible for both Medicaid and Medicare, often covering costs that Medicare does not.
What is the Medicaid expansion under the Affordable Care Act (ACA)?
Answer: The ACA expanded Medicaid eligibility to cover more low-income individuals in states that opted to expand their Medicaid programs.
What ICD-10 code is used for chronic kidney disease, stage 3?
N18.3
True or False: Risk adjustment in Medicaid only applies to elderly populations.
Answer: False. Risk adjustment applies to all Medicaid populations, including children, pregnant women, and disabled individuals.
What is a CMS-1500 form, and what is its role in Medicaid billing?
Answer: The CMS-1500 form is used for submitting claims to Medicaid for services rendered, including all relevant diagnosis codes.
What are Medicaid managed care plans?
Answer: Medicaid managed care plans are private health insurance plans that contract with Medicaid to provide care to enrollees.