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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 basic responsibility of the National Correct Coding Initiative is to generate correct code initiative edits
The deadline for submitting TRICARE claims is within _____ of services rendered, after which no payment is made. 1 year
What is the first step an employee should take for a first report of a nonemergency on-the-job injury? The employee should notify a supervisor of the accident.
TRICARE’s health maintenance organization (HMO)-type option is TRICARE Prime
How frequently claims are submitted can vary depending on the type of claim & office staffing & the size of the practice
CHAMPVA is the payer of last resort after all other third-party payers have met their obligations except for Medicaid
TRICARE is organized into ____ geographic regions 6
A detailed and comprehensive questionnaire that establishes financial need is a/an financial means test
If a TRICARE-eligible beneficiary has other healthcare coverage, such as employer group or private insurance, TRICARE considers this other health insurance (OHI)
The condition in which the employee has reached a state of maximal medical improvement is called permanent and stationary
The TRICARE program is managed by _____ under the authority of the Office of the Assistant Secretary of Defense for Health Affairs (OSD/HA). the TRICARE Management Activity (TMA)
As an alternative to traditional workers’ compensation coverage, some employers choose a/an __________________ to provide medical care to injured employees. managed care system
In general, if a claim is reduced or rejected, the problem lies with the provider’s office
Enrollees are responsible for certain __________ for care that are covered under TRICARE Standard. cost shares
Which of the following employers are not required to provide workers’ compensation insurance to their employees? employers with fewer than three full-time employees, individuals who are business partners, &volunteers
A hospital or institutional provider, physician, or other provider of services or supplies specifically allowed to provide benefits under TRICARE is commonly referred to as a TRICARE authorized provider
When a coordination of benefits situation exists, the health insurance professional should first verify which payer is primary and which is secondary
The standard form for billing disability claims is nonexistent
When initiating an appeal, to make sure that the appropriate steps are followed, the health insurance professional should consult the carrier’s guidelines
Workers’ compensation is considered a/an legally mandated right
All of the following are benefits of the workers’ compensation program except food and housing expenses
The three basic plans under TRICARE include all of the following except Global
Documenting the appropriate medical information in the patient’s health record is the responsibility of the healthcare provider
The time limit for filing a workers’ compensation claim is established by individual state statutes
Created by: Iteach4Docs