Theory mod160 wk4

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Question

Answer

HIV infection can be reported if documented as "suspected" or "possible"

False

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When a patient is admitted for chemotherapy, assign the code for the malignancy as the first-listed diagnosis

False

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Assignment of diabetes codes are not affected by whether the patient is on insulin

True

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If a physician documents that the patient's diabetes is poorly controlled, a fifth digit for out of control should be assigned

False

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ICD-9-CM presumes a cause-and-effect relationship between hypertension and chronic kidney disease

True

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ICD-9-CM presumes a cause-and-effect relationship between hypertension and heart disease

False

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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

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The site in which a malignant neoplasm has spread to is the primary site

False

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Status asthmaticus is a term used for a very severe type of asthmatic attack

True

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If a patient is admitted for dehydration due to chemotherapy, the dehydration is the first-listed diagnosis

True

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For gastrointestinal hemorrhage to be coded, the patient must be actively bleeding

False

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An ectopic pregency occurs when the fertilized ovum implants outside the uterus, usually in the fallopian tube

True

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A V27 "outcome of delivery" code is assigned as an additional code to the baby's record

False

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A pathologic fracture is a break in a bone that occurs because of a bone disease or weak bone

True

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The perinatal period extends through the first 6 weeks following birth

False

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A code from Chapter 16 should not be assigned when it is considered to be routinely associated with a disease process

True

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Non-healing burns should be coded as a posttraumatic wound infection

False

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A complicated wound occurs when a tendon is involved

False

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An adverse effect occurs when a drug has been correctly prescribed and proplerly administered and the patient develops a reaction

True

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When coding a poisoning, also assign an E code from the therapeutic column from the Table of Drugs and Chemicals

False

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Individual's who qualify for TRICARE are known as subscribers

False

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A person retired from a career in the Armed Forces is eligible for TRICARE until 65 years of age

True

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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

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The NAS is required for outpatient services that are within the catchment area

False

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All dependents 10 years of age or older are required to have a military identification card for TRICARE

True

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A partnership program permits TRICARE-eligible people to recieve inpatient treatment from civilian providers of care in a military hospital

True

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A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries

True

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Providers may choose to accept TRICARE assignment on a case-by-case basis

True

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In the TRICARE Extra plan, the individual enrolls yearly and pays an annual fee

False

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Enrollment in TRICARE Prime is voluntary

True

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Active duty service members are eligible for TRICARE Extra

False

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All Privacy Act requests from patients must be made in writing

False

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TRICARE is subject to state regulatory agencies that control insurance policies

False

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TRICARE claims must be billed on a special claim form provided by the closest military facility within the area of treatment

False

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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

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TRICARE/CHAMPVA is usually the second payer when a beneficiary is enrolled in other health insurance plans

True

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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

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

The allowable amount 80%

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What does the acronym CHAMPVA stands for

Civilian Health and Medical Program of the Dept of Veteran Affairs

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Who determines eligibility in the CHAMPVA program

Department of Veteran

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

To verify information by way of computer matches

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Where are claims for patients on active duty sent

Palmetto Government Benefits Administrators (PGBA)the specific branch of service they enlisted in

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TRICARE, formerly known as CHAMPUS, is funded through

Congress

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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

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The health maintenance organization provided for dependents of active duty military personnel is called

TRICARE Prime

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People Not entitled to benefits under TRICARE are

CHAMPVA beneficiaries

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What is the system called that TRICARE claims processors use to verify beneficiary eligibility

DEERS

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An NAS is a

Certification from a military hospital stating that is cannot provide the necessary care

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The NAS catchment area is

Based on an area of about 40 miles in radius surrounding each USMTF defined by a zip

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Medical care that is cost-shared by both TRICARE Standard and a civilian source is known as

Cooperative Care

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The TRICARE fiscal year extends from

Oct 1 to Sept 30

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Health care professionals who may treat a TRICARE patient are

doctors of medicine, doctyors of oseteopathy, psychologists

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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

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A physician who chooses not to particapte in TRICARE bills

no more than 115% of the TRICARE allowable charge

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Enrollment in TRICARE Prime is for

1year at a time

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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

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CHAMPVA is a/an

Service benefit program

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The Vetrens health Care Expansion Act of 1973 authorized the

CHAMPVA program

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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

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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

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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

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TRICARE Prime and TRICARE Extra claims are

Filed by the provider to a TRICARE subcontractor

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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

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