Question

When presenting a claim for payment under the Medicaid program, which of the following responsibilities must a provider undertake?

a) Have documentation of the service provided should be maintained in the provider’s file.
b) Ensure that iBudget waiver covered goods or services that are medically necessary.
c) Ensure that the quality of services is comparable to those provided to the general public by the provider’s peers.
d) All of the above.

Answer 1

When presenting a claim for payment under the Medicaid program, a provider must have documentation of the service provided, ensure that iBudget waiver covered goods or services are medically necessary, and ensure that the quality of services is comparable to those provided by their peers.

Step-by-step explanation:

When presenting a claim for payment under the Medicaid program, a provider must undertake the following responsibilities:

1. Have documentation of the service provided should be maintained in the provider’s file: This means that the provider must keep records of the services they have rendered, including documentation of the medical necessity of the services.
2. Ensure that iBudget waiver covered goods or services that are medically necessary: The iBudget waiver is a program that allows individuals with developmental disabilities to receive Medicaid services in community-based settings. Providers must ensure that any goods or services they claim payment for under the iBudget waiver are medically necessary.
3. Ensure that the quality of services is comparable to those provided to the general public by the provider’s peers: This means that the provider must meet certain quality standards and provide services that are equivalent to those provided by other healthcare providers.

Therefore, the correct answer is d) All of the above.