THEORY TEST
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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
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| The basic responsibility of the National Correct Coding Initiative is to generate | correct code initiative edits
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| The deadline for submitting TRICARE claims is within _____ of services rendered, after which no payment is made. | 1 year
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| 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.
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| TRICARE’s health maintenance organization (HMO)-type option is | TRICARE Prime
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| How frequently claims are submitted can vary depending on | the type of claim & office staffing & the size of the practice
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| CHAMPVA is the payer of last resort after all other third-party payers have met their obligations except for | Medicaid
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| TRICARE is organized into ____ geographic regions | 6
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| A detailed and comprehensive questionnaire that establishes financial need is a/an | financial means test
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| If a TRICARE-eligible beneficiary has other healthcare coverage, such as employer group or private insurance, TRICARE considers this | other health insurance (OHI)
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| The condition in which the employee has reached a state of maximal medical improvement is called | permanent and stationary
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| 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)
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| As an alternative to traditional workers’ compensation coverage, some employers choose a/an __________________ to provide medical care to injured employees. | managed care system
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| In general, if a claim is reduced or rejected, the problem lies with the | provider’s office
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| Enrollees are responsible for certain __________ for care that are covered under TRICARE Standard. | cost shares
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| 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
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| 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
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| When a coordination of benefits situation exists, the health insurance professional should first | verify which payer is primary and which is secondary
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| The standard form for billing disability claims is | nonexistent
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| When initiating an appeal, to make sure that the appropriate steps are followed, the health insurance professional should consult the | carrier’s guidelines
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| Workers’ compensation is considered a/an | legally mandated right
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| All of the following are benefits of the workers’ compensation program except | food and housing expenses
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| The three basic plans under TRICARE include all of the following except | Global
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| Documenting the appropriate medical information in the patient’s health record is the responsibility of the | healthcare provider
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| The time limit for filing a workers’ compensation claim is established by | individual state statutes
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