question

Individuals who qualify for TRICARE are known as subscribers.

answer

False

question

A person retired from a career in the Armed Forces is eligible for TRICARE until 65 years of age.

answer

True

question

An NAS certification is required for all TRICARE Standard, TRICARE Extra, and CHAMPVA beneficiaries who wish to receive treatment as inpatients at a civilian hospital and who live within a catchment area surrounding a Uniformed Services medical treatment facility.

answer

False

question

The NAS is required for outpatient services that are within the catchment area.

answer

False

question

All dependents 10 years of age or older are required to have a military identification card for TRICARE

answer

True

question

A partnership program permits TRICARE-eligible people to receive inpatient treatment from civilian providers of care in a military hospital.

answer

True

question

A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries.

answer

True

question

Providers may choose to accept TRICARE assignment on a case-by-case basis.

answer

True

question

In the TRICARE Extra plan, the individual enrolls yearly and pays an annual fee.

answer

False

question

Enrollment in TRICARE Prime is voluntary.

answer

True

question

Active duty service members are eligible for TRICARE Extra.

answer

False

question

All Privacy Act requests from patients must be made in writing.

answer

False

question

TRICARE is subject to state regulatory agencies that control insurance policies.

answer

False

question

TRICARE claims must be billed on a special claim form provided by the closest military facility within the area of treatment

answer

False

question

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.

answer

True

question

TRICARE/CHAMPVA is usually the second payer when a beneficiary is enrolled in other health insurance plans.

answer

True

question

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.

answer

False

question

TRICARE, formerly known as CHAMPUS, is funded through

answer

Congress

question

The three choices of health care coverage for families of active duty military personnel, military retirees, and their dependents are

answer

TRICARE Standard, TRICARE Prime, and TRICARE Extra

question

The health maintenance organization provided for dependents of active duty military personnel is called

answer

TRICARE Prime

question

People NOT entitled to benefits under TRICARE are

answer

CHAMPVA beneficiaries

question

What is the system called that TRICARE claims processors use to verify beneficiary eligibility?

answer

DEERS

question

An NAS is a

answer

certification from a military hospital stating that it cannot provide the necessary care

question

The NAS catchment area is

answer

Both A and C

question

Medical care that is cost-shared by both TRICARE Standard and a civilian source is known as

answer

Cooperative care

question

The TRICARE fiscal year extends from

answer

October 1st, to September 30th

question

Health care professionals who may treat a TRICARE patient are

answer

All of the above

question

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

answer

HCF

question

A physician who chooses not to participate in TRICARE bills

answer

no more than 115% of the TRICARE allowable charge.

question

Enrollment in TRICARE Prime is for

answer

1 year at a time

question

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

answer

PCM

question

CHAMPVA is a/an

answer

service benefit program

question

The Veterans Health Care Expansion Act of 1973 authorized the

answer

CHAMPVA Program

question

The wife of a veteran with total permanent disability resulting from a service-connected injury is eligible for CHAMPVA benefits

answer

Both A and B

question

The Privacy Act of 1974 establishes an individual's right to review his or her medical records maintained by a

answer

All of the above

question

The time limit within which a TRICARE outpatient claim must be filed is

answer

within 1 year from the date a service is provided

question

The time limit within which a TRICARE inpatient claim must be filed is within

answer

1 year from a patient's discharge from an inpatient facility

question

TRICARE Prime and TRICARE Extra claims are

answer

filed by the provider to a TRICARE subcontractor.

question

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

answer

individual time limits for each item on the claim

Chapter 14 – Insurance True/False & Multiple Choice – Flashcards

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