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MIBC F13

A Fordney Ch 13

QuestionAnswer
Individuals 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
The NAS may be attached to the paper claim for billing an outpatient procedure False
The NAS is required for outpatient service that are within the catchment area 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 receive 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 assignmenton 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 writting. 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 physician is nonparticipating and does not accept assignment, the patient completes the top portion of the CMS-1500 claim form, attaches an itemized statement from the physician, and submits the 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
TRICARE, formerly known as CHAMPUS, is funded through___ Congress
The three choices of health care coverage for families of active duty military personel, 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 NOTentitled to benefits under TRICARE are ___ CHAMPVA beneficiaries
What is the system called that TRICARE claims processors use to verify beneficiary eligibility___ TRI-CHECK
An NAS is a/an____ certification from a military hospital stating that it cannor provide the necessary care.
The NAS catchment area is___ defined by ZIP codes and based on an area of about 40 miles in radius surrounding each USMTF
Medical care that is cost-shared by both TRICARE Standard and a civilian source is known as ___ cooperative care
The TRICARE fisical year extends from __ October 1 to September
Health care professionals who may treat a TRICARE patient are ___ doctors of medicine, doctors of osteopathy, psychologists
A physician who chooses not to participate in TRICARE bills ___ no more than 115% of the TRICARE allowable charge.
Enrollment in TRICARE Prime is for ___ 1 year at a time
The physician who is responsible for coordinating and managing all of the health care for the TRICARE Prime patient is referred to as a/an ___ PCM Primary Care Manager
TRICARE Standard and CHAMPVA are ___ service/health benefit programs
The Vetrans 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 or 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, a VA hospital, U.S. Public Health Service facility
The time limit within which a TRICARE outpatient clain must be filed is ___ within 1 year from the date a service is provided
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: leemiller
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