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Theory mod160 wk4

Question	Answer
HIV infection can be reported if documented as "suspected" or "possible"	False
When a patient is admitted for chemotherapy, assign the code for the malignancy as the first-listed diagnosis	False
Assignment of diabetes codes are not affected by whether the patient is on insulin	True
If a physician documents that the patient's diabetes is poorly controlled, a fifth digit for out of control should be assigned	False
ICD-9-CM presumes a cause-and-effect relationship between hypertension and chronic kidney disease	True
ICD-9-CM presumes a cause-and-effect relationship between hypertension and heart disease	False
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
The site in which a malignant neoplasm has spread to is the primary site	False
Status asthmaticus is a term used for a very severe type of asthmatic attack	True
If a patient is admitted for dehydration due to chemotherapy, the dehydration is the first-listed diagnosis	True
For gastrointestinal hemorrhage to be coded, the patient must be actively bleeding	False
An ectopic pregency occurs when the fertilized ovum implants outside the uterus, usually in the fallopian tube	True
A V27 "outcome of delivery" code is assigned as an additional code to the baby's record	False
A pathologic fracture is a break in a bone that occurs because of a bone disease or weak bone	True
The perinatal period extends through the first 6 weeks following birth	False
A code from Chapter 16 should not be assigned when it is considered to be routinely associated with a disease process	True
Non-healing burns should be coded as a posttraumatic wound infection	False
A complicated wound occurs when a tendon is involved	False
An adverse effect occurs when a drug has been correctly prescribed and proplerly administered and the patient develops a reaction	True
When coding a poisoning, also assign an E code from the therapeutic column from the Table of Drugs and Chemicals	False
Individual's 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
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
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 recieve 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 assignment 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 writing	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 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
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



What payment does when assignment is accepted in a TRICARE case a participating provider agree to accept	The allowable amount 80%
What does the acronym CHAMPVA stands for	Civilian Health and Medical Program of the Dept of Veteran Affairs
Who determines eligibility in the CHAMPVA program	Department of Veteran
What does the Computer Matching and Privacy Protection Act of 1988 permit the government to do	To verify information by way of computer matches
Where are claims for patients on active duty sent	Palmetto Government Benefits Administrators (PGBA)the specific branch of service they enlisted in
TRICARE, formerly known as CHAMPUS, is funded through	Congress
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
The health maintenance organization provided for dependents of active duty military personnel is called	TRICARE Prime
People Not entitled to benefits under TRICARE are	CHAMPVA beneficiaries
What is the system called that TRICARE claims processors use to verify beneficiary eligibility	DEERS
An NAS is a	Certification from a military hospital stating that is cannot provide the necessary care
The NAS catchment area is	Based on an area of about 40 miles in radius surrounding each USMTF defined by a zip
Medical care that is cost-shared by both TRICARE Standard and a civilian source is known as	Cooperative Care
The TRICARE fiscal year extends from	Oct 1 to Sept 30
Health care professionals who may treat a TRICARE patient are	doctors of medicine, doctyors of oseteopathy, psychologists
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
A physician who chooses not to particapte in TRICARE bills	no more than 115% of the TRICARE allowable charge
Enrollment in TRICARE Prime is for	1year at a time
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
CHAMPVA is a/an	Service benefit program
The Vetrens 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 , as long as she is not eligible 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, VA hospital, Us Public Health Service facility
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: moviegrl

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