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TRICARE/HCPCS
LESSON 5/Tricare, HCPCS
Question | Answer |
---|---|
Explain the difference between the following four plans: TRICARE STANDARD | Is a fee-for-service, cost-sharing program that covers medical services provided by a civilian physician when an individual cannot receive treatment from an MTF. |
TRICARE EXTRA | Is a preferred provider organization (PPO) option, and an alternative managed care plan to Tricare Prime. |
TRICARE PRIME | Is a managed care plan, similar to an HMO. This program offers additional preventive care, including routine physical examinations. |
CHAMPVA | Is a comprehensive healthcare program in which the U.S. Department of veteran affairs (VA) shares the cost of covered healthcare services and supplies with veterans with 100% service-related disabilities and their families. |
What does DEERS stand for? | Defense Enrollment Eligibility Reporting System. |
When does TRICARE fiscal year begins? | October 1 |
What is the annual catastrophic cap for active duty families under TRICARE Standard? | $1000.00 |
What is the annual catastrophic cap for retirees under TRICARE Standard? | $7,500.00 |
What TRICARE plan does not require enrollment? | Tricare Standard |
Who administers the CHAMPVA program? | Health Administrator Center |
What does HCPCS stand for? | Healthcare common procedure coding system |
Why were HCPCS developed? | To report professional services, procedures, and supplies. Coordinates the government application insuring validity of profiles and fees scales, allowing the provider and supplier to be able to communicate. |
What is the format of a HCPC code and modifier? | HCPCS have one alphabetic character and four digits. The modifier has two digit codes which may be letters or letters plus numbers. |
What is an ABN? | Is an Advance Beneficiary Notice that the patient has to sign before the provider renders his/her services. |
What is Durable Medical Equipment (DME)? | An appliance, apparatus or product intended for use in assisting or treating a patient. |
Explain the difference in Level I HCPC codes: | HCPCS level 1 coding (CPT) is for medical procedures services. |
Explain the difference in Level II HCP codes: | Level 2 HCPCS codes (durable medical equipment) national codes consist of one letter between A and V, followed by four digits |
Are modifiers required in all HCPC codes? | No is not required |