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TRICARE/HCPCS

LESSON 5/Tricare, HCPCS

QuestionAnswer
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
Created by: Lizbeth Romo