Health Insurance Chap 8 & 11
Review week 1 mod 6
- 1.A combination federal/state medical assistance program that provides comprehensive and quality medical care for certain categories of low income and qualifying elderly people is
- A.
Medicare
- B.
Medicaid
- C.
Champva
- D.
Blue cross and blue shield
- 2.The acronym for the medicaid program that was formerly referred to as AFDC is
- A.
TANF
- B.
Hippa
- C.
Cobra
- D.
Tricare
- 3.To qualify for supplemental security income (SSI) individuals must meet certain financial guidelines set by
- A.
The U.S. constitution
- B.
Individual state laws
- C.
The federal poverty level (FPL)
- D.
The centers for medicare and medicaid services (CMS)
- 4.The amount of the SSI payment is the difference between the federal benefit rate (FBR) and the persons
- A.
Net worth
- B.
Average wage
- C.
Taxable income
- D.
Countable income
- 5.The medicaid program is administered by the
- A.
AMA
- B.
CMS
- C.
HIPPA
- D.
NAFTA
- 6.In order to receive federal matching funds in its medicaid program title XIX of the social security act requires that states offer certain basic services called
- A.
Monitoring
- B.
Service matching
- C.
Mandated services
- D.
Medicaid equalization
- 7.Medically need individuals can reduce their assets to the medicaid eligibility level by deducting medical expenses this is called a/an
- A.
Use tariff
- B.
Spend down
- C.
Expense equalization
- D.
Medical expense payout
- 8.A commercial insurer contracted by the department of health and human services (HHS) for the purpose of processing and administering medicaid claims is a
- A.
Claims contractor
- B.
Fiscal intermediary
- C.
Commercial advisor
- D.
Medicaid administrator
- 9.Individuals who receive medical assistance because their income falls within the poverty or FPL guidelines or as a result of SSI eligibility are considered
- A.
Medically needy
- B.
Medically deprived
- C.
Categorically needy
- D.
Medically challenged
- 10.The acronym for the program that provides comprehensive alternative care for non institutionalized elderly who otherwise would be in a nursing home is
- A.
PACE
- B.
COBRA
- C.
SCHIP
- D.
EMTLA
- 11.As a general rule medicaid pays only for services that are
- A.
Over $100
- B.
Experimental
- C.
Federally mandated
- D.
Medically necessary
- 12.Before providing services to patients claiming to be on medicaid the health insurance professional should
- A.
Complete a claim
- B.
Verify eligibility
- C.
Check references
- D.
Ask for payment upfront
- 13.An individual who is eligible for both medicare and medicaid programs is said to be a/an
- A.
Dual eligible
- B.
Dual qualifier
- C.
Elderly qualifier
- D.
Tax exempt aged
- 14.When an individual is covered under both medicaid and medicare and/or a private healthcare policy the payer of last resort is always
- A.
Medicare
- B.
Medicaid
- C.
Medigap
- D.
The private insurer
- 15.When one state allows medicaid beneficiaries to be treated in an adjacent state it is referred to as
- A.
Illegal
- B.
Joint care
- C.
Reciprocity
- D.
Dual state eligibility
- 16.When a medicaid beneficiary has no other healthcare coverage the type of claim to be submitted is called a
- A.
State claim
- B.
Unilateral claim
- C.
Functional claim
- D.
Medicaid simple claim
- 17.Congress established the medicaid program under title XIX of the social security act in 1965
- A.
True
- B.
False
- 18.Every state has the medicaid benefits
- A.
True
- B.
False
- 19.There is a medicaid program in all 50 states the district of columbia and u.s. territories
- A.
Ture
- B.
False
- 20.CMS determines eligibility criteria for SSI
- A.
True
- B.
False
- 21.The federal government establishes broad national guidelines for medicaid eligibility and each state establishes its own eligibility standards within federal guidelines
- A.
True
- B.
False
- 22.States must cover categorically needy individuals but are free to define this category
- A.
True
- B.
False
- 23.States must participate in the state childrens health insurance program (SCHIP)
- A.
True
- B.
False
- 24.Individuals meeting family medical criteria fall into the medically needy category
- A.
True
- B.
False
- 25.Hospitals that receive additional payments to ensure that communities have access to certain high cost services are called disproportional share hospitals
- A.
True
- B.
False
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