Medicaid
Medicare
Vocab
Which of the following?
Etc..
100
The two Medicaid eligibility classifications
What is categorically and medically needy?
100
Medicare provides insurance for people THIS many years of age.
What is 65?
100
A secondary insurance policy purchased by the patient that covers the patient's Medicare deductible and coinsurance
What is medigap?
100
are covered by Medicare Part A? Physician outpatient services, physical therapy, outpatient surgery, hospice care.
What is Hospice Care?
100
The Social Security Act of 1935 did THIS.
What is set up the the public assistance programs?
200
Timely filing limits for the state of South Carolina
What is 12 months?
200
Medicare outpatient coverage.
What is Part B?
200
The REAL name of the legislation passed in 2010 that requires all Americans to have health insurance coverage.
What is Patient Protection and Affordable Care Act?
200
is covered under Medicare Part B? diagnostics tests, hospital rooms, hospice care, nursing care facilities.
What is diagnostic tests?
200
Medicaid managed care patient claims should be sent to the..
What is Managed care organization and NOT the Medicaid fiscal agent?
300
Medicaid is administered by...
What is state government with partial federal funding.
300
When Medicare transmits a claims adjudication information electronically to another insurance plan
What is crossover claim?
300
Medical services that are not included in a managed care contract's fee schedule but may be contracted for separately.
What are carve outs?
300
is the name of the organization of physicians sponsored by a state or local medical associated that is concerned with the delivery of medical services and the cost of health care? foundation for medical care, physician provider group, health care cost containment organization, professional review organization
What is foundation for medical care?
300
When a Medicaid patient requires a piece of durable medical equipment, the physician must...
What is obtain prior authorization, preferably written?
400
The only state without a Medicaid program that is similar to those existing on other states that has an alternative prepaid medical assistance program.
What is Arizona?
400
When a Medicare Part A benefit period ends
What is when a patient has not been in a bed in any hospital or nursing facility for 60 consecutive days?
400
Assigning an inaccurate CPT code to increase reimbursement.
What is upcoding?
400
Is the correct procedure to collect a copayment on a managed care plan? There is no copayment with a managed care plan, bill the plan for the copayment, bills the patient for the copayment, collect the copayment when the patient arrives for the office visit.
What is Collect the copayment when the patient arrives for the office visit?
400
When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person
What is capitation?
500
If a physician accepts Medicaid patients, the physician must also agree to accept THIS.
What is the Medicaid allowed amount?
500
When a Medicare patient signs and ABN, the procedure cost for the service must be appended with this modifier.
What is -GA?
500
The explanation of benefits document for Medicare patients.
What is Medicare Summary Notice?
500
Is the purpose of the ABN? To inform the patient that they are about to receive a service that may not be covered by Medicare, to ensure that the provider gets reimbursed by Medicare for a non-covered service that the patient wants to receive, to ensure correct coding and billing for potentially non-covered services for Medicare beneficiaries, all of the above.
What is all of the above?
500
An organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used.
What is Preferred provider organization (PPO)?
M
e
n
u