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Mod H Unit 3
Review
| Question | Answer |
|---|---|
| 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 | • |
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