Worksheet assigned chapters. Due 12/21/11

Fordney: Insurance Handbook for the Medical Office, 11th Edition

Chapter 13: Medicaid and Other State Programs, Chapter 14: TRICARE and CHAMPVA, Chapter 15: Workers’ Compensation

1) In the Medicaid program, Congress authorized vendor payments for medical care, which are payments from the

a. / federal government directly to welfare recipients.
b. / welfare agency directly to the physician.
c. / welfare agency directly to welfare recipients.
d. / state agency directly to welfare recipients.

2) Medicaid is administered by the

a. / federal government.
b. / federal government with partial state funding.
c. / state government with partial federal funding.
d. / state government.

3) The federal aspects of Medicaid are the responsibility of the

a. / AMA.
b. / AHA.
c. / HIAA.
d. / CMS.

4) Medicaid is available to needy and low-income people such as

a. / the blind.
b. / the disabled.
c. / the aged (65 years or older).
d. / All of the above

5). Basic Maternal and Child Health Program (MCHP) provisions offered in all states include

a. / children with handicap needs who require orthopedic treatment or plastic surgery.
b. / children with hearing problems.
c. / children with mental retardation.
d. / children with paralyzed muscles.

6. If a physician accepts Medicaid patients, the physician must accept

a. / the Medicaid-allowed amount.
b. / the Medicare-allowed amount.
c. / an amount equal to his or her regular fee schedule.
d. / the Medicaid-allowed amount plus 20%, which may be collected from the patient.

7. Medicaid eligibility must always be checked for the

a. / month of service.
b. / type of service.
c. / year of service.
d. / Both A and B

8. The Medicaid service for prevention, early detection, and treatment for welfare children is known as

a. / CHPS.
b. / EPSDT.
c. / EPDT.
d. / CHAP.

ANS: B

9. ) Medicaid managed care patient claims should be sent to the

a. / Medicaid fiscal agent or carrier.
b. / state government office.
c. / local Medicaid office.
d. / managed care organization and not the Medicaid fiscal agent.

10.) The time limit to appeal a claim varies from state to state, but it is usually

a. / 30 to 60 days.
b. / 90 to 120 days.
c. / 6 months.
d. / 1 year.

SHORT ANSWER ( Chapter 14)

1. What payment does a participating provider agree to accept when assignment is accepted in a TRICARE case?

2. What does the acronym CHAMPVA stand for?

ANS:

3. Who determines eligibility in the CHAMPVA program?

4. What does the Computer Matching and Privacy Protection Act of 1988 permit the government to do?

5. Where are claims for patients on active duty sent?

SHORT ANSWER ( Chapter 15)

1. Which types of employees fall under federal workers’ compensation statutes?

2. Name the three types of state workers’ compensation disability claims.

3. Name the five types of workers’ compensation benefits.

4. What is the name of the form that authorizes the physician to treat the employee?

5. What formal report is sometimes required to inform the insurance carrier that the patient is able to return to work?