Health Insurance Chap 8 & 11

54 Questions | Total Attempts: 170

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Health Insurance Quizzes & Trivia

Review week 1 mod 6


Questions and Answers
  • 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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