A Medi Medi Beneficiary Is An Individual

Question: Medicaid beneficiaries must meet
Answer: both minimum federal requirements as well as any additional state requirements.
==================================================
Question: Applicants who have high medical bills and whose incomes exceed state limits may be eligible for health care coverage under a state ______ program.
Answer: medically needy
==================================================
Question: Under the Federal Medicaid Assistance Program, the federal government makes payment directly to
Answer: states
==================================================
Question: Most individuals receiving TANF payments are limited to a ______ -year benefit period.
Answer: five
==================================================
Question: Under Medicaid, optional services commonly include
Answer: prosthetic devices
==================================================
Question: People classified as restricted status
Answer: must see a specific provider for treatment
==================================================
Question: If family planning services are provided to a patient, what data element is affected?
Answer: family planning indicator
==================================================
Question: If services were provided in an emergency room, what place of service code is reported (Hint: Refer to Appendix B)?
Answer: 23
==================================================
Question: The Medicaid Alliance for Program Safeguards
Answer: oversees states fraud and abuse efforts.
==================================================
Question: The national committee to coordinate Medicaid data elements on health care claims is called
Answer: NMEH
==================================================
Question: To provide services to Medicaid recipients, physicians must sign a contract with the
Answer: HHS
==================================================
Question: The federal government requires states to offer Medicaid benefits to children whose family income is under ____ percent of the poverty level.
Answer: 133
==================================================
Question: A Medi-Medi beneficiary's claim information is usually:
Answer: sent by Medicare to Medicaid as the secondary payer
==================================================
Question: A crossover claim is automatically:
Answer: transmitted by the primary payer to the secondary payer.
==================================================
Question: The medical insurance specialist should check patients' Medicaid eligibility:
Answer: each time an appointment is made
==================================================
Question: Categorically needy people in the Medicaid program usually have
Answer: low incomes
==================================================
Question: The Affordable Care Act is expected to add how many million people into the Medicaid program?
Answer: 16 million
==================================================
Question: CHIP is the abbreviation for
Answer: Children's Health Insurance Program.
==================================================
Question: TANF is the abbreviation for
Answer: Temporary Assistance for Needy Families.
==================================================
Question: A Medi-Medi beneficiary is an individual:
Answer: who is eligible for coverage from both Medicaid and Medicare
==================================================
Question: EPSDT is the abbreviation for
Answer: Early and Periodic Screening, Diagnosis, and Treatment.
==================================================
Question: Assets include all of the following except:
Answer: burial plot
==================================================
Question: The Temporary Assistance for Needy Families provides which of the following?
Answer: financial assistance to beneficiaries
==================================================
Question: A person eligible for Medicaid in a given state is
Answer: not necessarily eligible in all other states.
==================================================
Question: __________ is the state Medicaid program name in California.
Answer: MediCal
==================================================
Question: If a provider chooses not to participate in TRICARE, they may charge no more than _______ percent of the allowable charge.
Answer: 115
==================================================
Question: What is the TRICARE Standard annual cap for active-duty families?
Answer: $1,000
==================================================
Question: What is the term for the maximum amount TRICARE will pay for a procedure?
Answer: TMAC
==================================================
Question: Once the catastrophic cap has been met, what percentage of the additional charges for covered services for that coverage year will TRICARE pay?
Answer: 100 percentage
==================================================
Question: What program did TRICARE replace?
Answer: CHAMPUS
==================================================
Question: TRICARE will only pay for services that are rendered by _______________ providers.
Answer: authorized
==================================================
Question: What is the TRICARE term for coinsurance?
Answer: cost share
==================================================
Question: What should be checked on a patient's military ID card to confirm if it is valid?
Answer: the expiration date
==================================================
Question: Patient cost-share payments are subject to an annual ______________, a limit on the total medical expenses that beneficiaries are required to pay in one year.
Answer: catastrophic cap
==================================================
Question: Which of the following is the uniformed services member in a family qualified for TRICARE?
Answer: sponsor
==================================================
Question: Who is responsible for the charges if a TRICARE managed care patient visits a provider who chooses not to join the TRICARE network?
Answer: the patient
==================================================
Question: When does TRICARE's fiscal year run?
Answer: October 1 through September 30
==================================================
Question: Name the Department of Defense's health insurance plan for military personnel and their families.
Answer: TRICARE
==================================================
Question: Where is information about TRICARE patient eligibility stored?
Answer: DEERS
==================================================
Question: The TRICARE plan that is an HMO and requires a PCM is
Answer: TRICARE Prime.
==================================================
Question: ______ enrollees receive priority at military treatment facilities.
Answer: Active-duty service members
==================================================
Question: A TRICARE for Life beneficiary must be at least ______ years old.
Answer: sixty five
==================================================
Question: If a TRICARE Standard enrollee sees a provider for an outpatient visit, TRICARE pays ______ percent of the covered charges.
Answer: 80
==================================================
Question: The TRICARE health care program is a covered entity and subject to privacy rules under
Answer: HIPPA
==================================================
Question: A person enrolled in CHAMPVA is responsible for ______ percent of covered charges.
Answer: 25
==================================================
Question: Nonparticipating TRICARE providers cannot bill for more than ______ percent of allowable charges.
Answer: 115
==================================================
Question: Active-duty service members are automatically enrolled in
Answer: TRICARE Prime
==================================================
Question: For individuals enrolled in TRICARE for Life, the primary payer is
Answer: Medicare
==================================================
Question: Decisions about an individual's eligibility for TRICARE are made by the
Answer: branch of military service.
==================================================
Question: The TRICARE program that offers an HMO-like plan requiring no annual deductible is
Answer: TRICARE Prime.
==================================================
Question: Physician Quality Reporting System
Answer: CMS program that provides incentives based
on performance measurements
==================================================
Question: Medicare Remittance Notice
Answer: Sent to the provider to explain how a claim
was processed
==================================================
Question: Advance beneficiary notice of noncoverage
Answer: Medicare form used to notify a patient that an
item or service may not be covered
==================================================
Question: Timely filing
Answer: Medicare law requiring claims to be filed
within one calendar year
==================================================
Question: Medicare Summary Notice
Answer: Sent to the patient to explain how benefits
were applied
==================================================
Question: Medicare Advantage
Answer: Medicare plans other than the Orignal
Medicare Plan
==================================================
Question: Medicare
Answer: the federal health insurance program for
people who are sixty five or older.
==================================================
Question: The Original Medicare Plan requires a premium, deductible and:
a) Medigap
b) coinsurance/cost-sharing
c) supplemental insurance
d) a formulary
Answer: b) coinsurance/cost-sharing
==================================================
Question: What percentage of the allowed amount does Medicare pay participating providers?
a) 75%
b) 80%
c) 90%
d) 100%
Answer: b) 80%
==================================================
Question: Medicare claims must be submitted_____
a) Within 6 months of the date of service
b) By the end of the calendar year following the service
c) Within one calendar year of the service
d) Within 90 days of service
Answer: c) Within one calendar year of the service
==================================================
Question: When a Medicaid patient has other coverage, Medicaid is
a) pays 80% of the allowed amount
b) canceled
c) payer of last resort
d) pays primary
Answer: c) payer of last resort
==================================================
Question: CHIPs covers children up to age ____________.
a) 21
b) 26
c) 19
d) 18
Answer: c)19
==================================================
Question: When a Medicaid patient has other coverage, Medicaid is
a) pays 80% of the allowed amount
b) canceled
c) payer of last resort
d) pays primary
Answer: c) payer of last resort
==================================================
Question: An individual eligible for both Medicaid and Medicare is known as a ______
a) Medicare administrative contractor
b) Medicare beneficiary
c) Medigap beneficiary
d) Medi-Medi beneficiary
Answer: d) Medi-Medi beneficiary
==================================================
Question: TANF
Answer: Government program that provides cash
assistance for lower income families.
==================================================
Question: payer of last resort
Answer: Regulation that Medicaid pays last on a claim
when a patient has other insurance coverage
==================================================
Question: medically indigent
Answer: Medical classification for people with high
medical expenses and low financial
resources.
==================================================
Question: categorically needy
Answer: A person who receives assistance from
government programs such as TANF.
==================================================