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Theory mod160 wk4

QuestionAnswer
HIV infection can be reported if documented as "suspected" or "possible" False
When a patient is admitted for chemotherapy, assign the code for the malignancy as the first-listed diagnosis False
Assignment of diabetes codes are not affected by whether the patient is on insulin True
If a physician documents that the patient's diabetes is poorly controlled, a fifth digit for out of control should be assigned False
ICD-9-CM presumes a cause-and-effect relationship between hypertension and chronic kidney disease True
ICD-9-CM presumes a cause-and-effect relationship between hypertension and heart disease False
A fifth digit of 3(in remission) should be assigned to 305.0X for someone who has abused alcohol in the past, but no longer drinks alcohol True
The site in which a malignant neoplasm has spread to is the primary site False
Status asthmaticus is a term used for a very severe type of asthmatic attack True
If a patient is admitted for dehydration due to chemotherapy, the dehydration is the first-listed diagnosis True
For gastrointestinal hemorrhage to be coded, the patient must be actively bleeding False
An ectopic pregency occurs when the fertilized ovum implants outside the uterus, usually in the fallopian tube True
A V27 "outcome of delivery" code is assigned as an additional code to the baby's record False
A pathologic fracture is a break in a bone that occurs because of a bone disease or weak bone True
The perinatal period extends through the first 6 weeks following birth False
A code from Chapter 16 should not be assigned when it is considered to be routinely associated with a disease process True
Non-healing burns should be coded as a posttraumatic wound infection False
A complicated wound occurs when a tendon is involved False
An adverse effect occurs when a drug has been correctly prescribed and proplerly administered and the patient develops a reaction True
When coding a poisoning, also assign an E code from the therapeutic column from the Table of Drugs and Chemicals False
Individual's who qualify for TRICARE are known as subscribers False
A person retired from a career in the Armed Forces is eligible for TRICARE until 65 years of age True
An NAS certification is required for all TRICARE Standard, TRICARE Extra, and CHAMPVA beneficiaries who wish to recieve treatment as inpatients at a civilian hospital False
The NAS is required for outpatient services that are within the catchment area False
All dependents 10 years of age or older are required to have a military identification card for TRICARE True
A partnership program permits TRICARE-eligible people to recieve inpatient treatment from civilian providers of care in a military hospital True
A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries True
Providers may choose to accept TRICARE assignment on a case-by-case basis True
In the TRICARE Extra plan, the individual enrolls yearly and pays an annual fee False
Enrollment in TRICARE Prime is voluntary True
Active duty service members are eligible for TRICARE Extra False
All Privacy Act requests from patients must be made in writing False
TRICARE is subject to state regulatory agencies that control insurance policies False
TRICARE claims must be billed on a special claim form provided by the closest military facility within the area of treatment False
For a CHAMPVA beneficiary if the phys is non par and does not accept assign the patient completes the top portion of the CMS claim form, attaches an itemized statement from doc and submits claim True
TRICARE/CHAMPVA is usually the second payer when a beneficiary is enrolled in other health insurance plans True
TRICARE is considered primary to Medicare for people younger than age 65 who have Medicare Part A as a result of a disability and who have enrolled in Medicare Part B False
What payment does when assignment is accepted in a TRICARE case a participating provider agree to accept The allowable amount 80%
What does the acronym CHAMPVA stands for Civilian Health and Medical Program of the Dept of Veteran Affairs
Who determines eligibility in the CHAMPVA program Department of Veteran
What does the Computer Matching and Privacy Protection Act of 1988 permit the government to do To verify information by way of computer matches
Where are claims for patients on active duty sent Palmetto Government Benefits Administrators (PGBA)the specific branch of service they enlisted in
TRICARE, formerly known as CHAMPUS, is funded through Congress
The three choices of health care coverage for families of active duty military personnel, military retirees and their dependents are TRICARE Standard, Tricare Prime and TRICARE Extra
The health maintenance organization provided for dependents of active duty military personnel is called TRICARE Prime
People Not entitled to benefits under TRICARE are CHAMPVA beneficiaries
What is the system called that TRICARE claims processors use to verify beneficiary eligibility DEERS
An NAS is a Certification from a military hospital stating that is cannot provide the necessary care
The NAS catchment area is Based on an area of about 40 miles in radius surrounding each USMTF defined by a zip
Medical care that is cost-shared by both TRICARE Standard and a civilian source is known as Cooperative Care
The TRICARE fiscal year extends from Oct 1 to Sept 30
Health care professionals who may treat a TRICARE patient are doctors of medicine, doctyors of oseteopathy, psychologists
A health care professional usually a registered nurse who helps the patient work with his or her primary care manager to locate a specialist or obtain a preauthorization for care is referred to as a/an HCF
A physician who chooses not to particapte in TRICARE bills no more than 115% of the TRICARE allowable charge
Enrollment in TRICARE Prime is for 1year at a time
The physician who is responsible for coordinating and manageing all of the health care for the TRICARE Prime patient is referref to as/an PCM
CHAMPVA is a/an Service benefit program
The Vetrens health Care Expansion Act of 1973 authorized the CHAMPVA program
The wife of a veteran with total permanent disability resulting from a service connected injury is eligible for CHAMPVA benefits As long as she is not eligible for TRICARE Standard , as long as she is not eligible for MEDICARE Part A
The privacy Act of 1974 establishes an individual's right to review his or her medical records maintained by a Federal medical care facility, VA hospital, Us Public Health Service facility
The time limit within which a TRICARE inpatient claim must be filed is within 1 year from a patient's discharge from an inpatient facility
TRICARE Prime and TRICARE Extra claims are Filed by the provider to a TRICARE subcontractor
If a TRICARE Extra claim is submitted with several items and several dates of service the time limit that would apply to the claim for filing would be Individual time limits for each item on the claim
Created by: moviegrl on 2011-07-08



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