H08V EXAM 4 ANSWERS - ASHWORTH

H08V EXAM 4 ANSWERS - ASHWORTH

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H08V Medical Coding II Exam 4 Answers (Ashworth)
Question 1

0 / 2.5 points
If a state elects to have a medically needy program, it’s required to cover all of the following except
Question options:
a) 
children living at home up to age 26.

b) 
prenatal care.

c) 
birth care.

d) 
ambulatory care for children.

Question 2

2.5 / 2.5 points
Medicaid is health insurance coverage for
Question options:
a) 
the aged.

b) 
the disabled.

c) 
low-income individuals.

d) 
those with end-stage renal disease (ESRD).

Question 3

2.5 / 2.5 points
A baby was just born to a mother who is on Medicaid. The baby may be considered to fall under which one of the following categories?
Question options:
a) 
Medically Needy

b) 
Categorically Needy

c) 
Special Group

d) 
FMAP

Question 4

2.5 / 2.5 points
A physician performed a procedure on a Medicaid patient and the claim was given a final denial of “medically unnecessary.” What will probably happen with the claim?
Question options:
a) 
The physician’s office will resubmit the claim to Medicaid.

b) 
The physician’s office will bill the patient for the full amount.

c) 
The physician’s office will bill the patient for 20% of the amount.

d) 
The physician’s office will write off the claim and not be reimbursed.

Question 5

0 / 2.5 points
If a Medicaid patient is on restricted status, that means he or she
Question options:
a) 
is required to see a specific physician or pharmacy.

b) 
is in a waiting period for coverage.

c) 
isn’t covered by Medicaid.

d) 
is prevented from using a particular service.

Question 6

0 / 2.5 points
A person living in a medical institution with a monthly income of 250% of the SSI income standard is considered to be
Question options:
a) 
categorically needy.

b) 
medically needy.

c) 
paralegal or a “special group.”

d) 
ineligible for Medicare.

Question 7

2.5 / 2.5 points
Under Medicaid, which one of the following choices could be categorized as “categorically needy”?
Question options:
a) 
Recipients of foster care assistance

b) 
Those who need assistance, but make too much money

c) 
Anyone covered by SSI

d) 
Those enrolled in SCHIP

Question 8

2.5 / 2.5 points
A doctor wants to start seeing Medicaid patient and receive Medicaid reimbursement. What’s important for the doctor to know?
Question options:
a) 
Medicaid diagnosis codes are different than those of other insurers.

b) 
Medicaid claims can be submitted only on the 1st and 15th of each month.

c) 
Medicaid patients can’t be billed for additional payment after Medicaid payment is received.

d) 
Medicaid providers must adhere to AMA certification guidelines.

Question 9

2.5 / 2.5 points
When filing a Medicaid claim, why would you leave the form locator for “Other Insured’s Name” blank?
Question options:
a) 
Because Medicaid is the payer of last resort

b) 
Because you need a verification number for the other insured

c) 
Because your office doesn’t work with that field

d) 
Because the patient doesn’t have his Medicaid paperwork

Question 10

2.5 / 2.5 points
What affect does the Affordable Care Act have on Medicaid?
Question options:
a) 
It increases the number of people eligible for Medicaid.

b) 
It decreases the number of people eligible for Medicaid.

c) 
It increases reimbursement to patients enrolled in Medicaid.

d) 
It decreases reimbursement to patients enrolled in Medicaid.

Question 11

2.5 / 2.5 points
A patient has a spend-down level of $200 each month. What does this mean?
Question options:
a) 
The patient must spend that amount each month before she’s covered by Medicaid.

b) 
The patient is reimbursed only $200 under her Medicaid plan.

c) 
The patient is reimbursed only on claims greater than $200.

d) 
The provider can bill the patient only $200.

Question 12

2.5 / 2.5 points
Which one of the following choices is a service that states can choose to offer under Medicaid?
Question options:
a) 
Prenatal care

b) 
Vision coverage

c) 
Vaccinations

d) 
Blood tests

Question 13

0 / 2.5 points
Most claims must be received be Medicaid within _______ or they won’t be paid.
Question options:
a) 
95 days from date of service

b) 
30 days from date of service

c) 
90 days from onset of illness

d) 
180 days from date of service

Question 14

2.5 / 2.5 points
Which of the following is responsible for determining the type, amount, and scope of services covered by Medicaid?
Question options:
a) 
The Centers for Medicare and Medicaid Services (CMS)

b) 
The federal government

c) 
Each state government

d) 
Contracted insurance carriers

Question 15

0 / 2.5 points
A patient has a spend-down level of $50. She goes to the doctor for the flu on January 25, then has a follow-up appointment on February 3. The physician bills $75 per visit. Which of the following statements is true?
Question options:
a) 
The patient will owe $100 for the two visits.

b) 
The patient will owe $50 for the two visits.

c) 
Medicaid will pay $50 for each visit.

d) 
Medicaid will pay $25 for the first visit and $75 for the second, since it’s within a month.

Question 16

0 / 2.5 points
A patient has Medicaid plus another insurance. How should Medicaid be billed?
Question options:
a) 
As the primary insurer

b) 
As the secondary insurer

c) 
As the only insurer

d) 
It depends on the other insurance.

Question 17

2.5 / 2.5 points
Which of the following programs provides an alternative to institutional care for people over age 55?
Question options:
a) 
PACE

b) 
EPSDT

c) 
TANF

d) 
HCBS

Question 18

2.5 / 2.5 points
Which of the following services is optional for states to cover under Medicaid?
Question options:
a) 
Prosthetic devices

b) 
Outpatient care

c) 
Nurse-midwife services

d) 
Family planning

Question 19

2.5 / 2.5 points
A Medicaid patient has a primary care physician whom she must go through if she needs to see a specialist. This patient is working under which Medicaid model?
Question options:
a) 
PCCM

b) 
PHP

c) 
RAC

d) 
TEFRA

Question 20

2.5 / 2.5 points
_______ limits a family’s lifetime benefits to a maximum of five years.
Question options:
a) 
TANF

b) 
CHIP

c) 
SSI

d) 
CHIPRA



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