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Mod H Unit 3


If a TRICARE-eligible beneficiary has other health care coverage, such as employer group or private insurance, TRICARE considers this other health insurance
Congress authorized the creation of the Emergency Maternal and Infant Care program (EMIC) during WWII
TRICARE’s health maintenance organization (HMO)-type option is Tricare Prime
The name of the total health care system of the U.S. uniformed services is called Military Health System
TRICARE’s preferred provider organization (PPO) is Tricare Extra
Military service personnel in the Army Reserves and National Guard are called reserved components
The fee-for-service option that has basically the same benefits as original CHAMPUS is Tricare Standard
A detailed and comprehensive questionnaire that establishes financial need is a financial means test
A comprehensive health benefits program available to uniformed services retirees, their spouses, and survivors who are 65 or older is called Tricare for Life
The time limit for filing a workers’ comp claim is established by individual state statutes
The deadline for submitting TRICARE claims is within ____________________ of services rendered 1 yr
What act provides workers’ compensation to employees of private maritime employers Long Shore & Harbor workers comp
CHAMPVA eligibility can be lost in what situations widow remarries, spouse divorce sponsor, dependant child turns 18
Health care professionals filing CHAMPVA claims should use the CMS-1500
All CHAMPVA claims, whether electronic or paper, should be sent to the VA Health Administration Center in Denver, Co
Examples of procedures/services for which preauthorization may be required for CHAMPVA beneficiaries include routine dental care, hospice care, treatment for substance abuse
The three basic plans included in the TRICARE program are Standard, Extra, Prime
The spouse or dependent child of a veteran who has been rated by a VA regional office as having a permanent and total service-connected condition or disability is eligible for CHAMPVA
Active duty, retired or deceased service members are called Sponsors
Eligibility can be confirmed by asking to see a Uniformed Services ID card or a family member’s Uniformed Services ID card or by calling DEERS
Uniformed service members and their families who are on remote assignment 50 miles or more from a MTFRC and RCs and their family members called to active duty for 179 days or more may be eligible for Tricare Prime Remote
A statement of certification from the MTF that says it cannot provide the specific health care the beneficiary needs is referred to as a nonavailability statement
The two major classifications of disability coverage are short term & long term
What classifications of businesses are not required to provide workers’ compensation for their employees business who employ casual employees
Irresponsible on-the-job actions such as horseplay and/or use of illegal drugs can result in denial of Workers Comp
The type of code that contains the full description of the procedure without additional explanation is the stand alone code
How many levels of procedural coding are there 3
What must accompany the claim when a rarely used, unusual, variable, or new service is performed special report
How many levels of procedural coding are there E & M
What symbol is used to show that the code has been changed or modified triangle
Following the six sections listed in the main body of the CPT manual are the category III codes
A main term can stand alone, or it can be followed up by three modifying terms
In CPT coding, a patient who was seen on October 1, 2008, and then not seen again in the same medical practice until August 30, 2010, is classified as a established Pt
Levels of service are based on three key components, including Hx, examination, complex MDM
A patient’s medical record must contain sufficient documentation to support the use of modifiers
The reason that the patient is seeing the physician, usually stated in his or her own words, is known as the Chief Complaint
CPT codes can be displayed three different ways single code, multiple codes,& range of codes
The time the health care provider spends in direct contact with a patient is called face to face time
The AMA 5-digit codes used for reporting services performed by healthcare professionals are Level 1 codes
The purpose of CPT coding.is to provide a uniform language that accurately describe professional service performed
Symbol indicating an add-on code +
Four factors can impact the E&M coding level reported. These are referred to as contributing factors
Symbol identifying a change in wording of a new/revised code >
Like history-taking, there are ____ degrees of patient examination 4
Symbol used to indicate codes for vaccines pending FDA approval Ϟ
Time is never a factor when a patient is seen in Emergency department
How many diagnostic and treatment options were considered; the amount and complexity of data reviewed; and the amount of risk for complications, morbidity, or mortality determine the complexity of decision making
Symbol identifying codes that include conscious sedation ʘ
Symbol denoting modifier-exempt codes Ø
Symbol representing a code that is new to the CPT book
Created by: pdeal