Chapter 13 & 14 – Flashcards
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Which of the following is an aid program under Medicare for low-income patients?
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Medicaid Qualified Medicare Beneficiary Program, Specified Low-Income Medicare Beneficiary Program, Qualifying Individuals Program
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When a Medicaid patient has Medicare, TRICARE, or CHAMPVA, Medicaid should be billed
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second
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Though the time limit to appeal a claim varies from state to state, generally an appeal must be filed within
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30-60 days.
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Conditions that do NOT qualify children for the Maternal Child Health Program in all states participating in Medicaid include
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epilepsy
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TRICARE claims must be billed on a special claim form provided by the closest military facility within the area of treatment
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False
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A partnership program permits TRICARE-eligible people to receive inpatient treatment from civilian providers of care in a military hospital.
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True
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Providers may choose to accept TRICARE assignment on a case-by-case basis
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True
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A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries
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True
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The time limit within which a TRICARE outpatient claim must be filed is
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within 1 year from the date a service is provided
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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
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PCM
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TRICARE/CHAMPVA is usually the second payer when a beneficiary is enrolled in other health insurance plans.
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True
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The Veterans Health Care Expansion Act of 1973 authorized the
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CHAMPVA program.
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TRICARE is subject to state regulatory agencies that control insurance policies.
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False
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What is the system called that TRICARE claims processors use to verify beneficiary eligibility?
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DEERS
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The health maintenance organization provided for dependents of active duty military personnel is called
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TRICARE Prime
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The time limit within which a TRICARE inpatient claim must be filed is within
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1 year from a patient's discharge from an inpatient facility.
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The three choices of health care coverage for families of active duty military personnel, military retirees, and their dependents are
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TRICARE, TRICARE Plus, and TRICARE Premium.
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TRICARE, formerly known as CHAMPUS, is funded through
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Congress.
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Enrollment in TRICARE Prime is voluntary
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True
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A person retired from a career in the Armed Forces is eligible for TRICARE until 65 years of age.
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True
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An NAS is a
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certification from a military hospital stating that it cannot provide the necessary care.
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People NOT entitled to benefits under TRICARE are
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CHAMPVA beneficiaries.
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The Privacy Act of 1974 establishes an individual's right to review his or her medical records maintained by a
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federal medical care facility, VA hospital, U.S. Public Health Service facility
