Deck 14: Tricare Medical Billing

Question 1

Once the standard annual catastrophic cap (maximum amount beneficiaries are required to pay within 1 year) has been met, for a beneficiary on TRICARE Standard or TRICARE Extra, TRICARE pays:

A) 25%.
B) 40%.
C) 60%.
D) 100%.

Answer 1

100%.

Question 2

The TRICARE fiscal year ends on:

A) January 31.
B) June 30.
C) September 30.
D) December 31.

Answer 2

September 30.

Question 3

The TRICARE preferred provider organization (PPO) plan option is:

A) TRICARE Standard.
B) TRICARE Extra.
C) TRICARE Prime.
D) CHAMPVA.

Answer 3

TRICARE Extra.

Question 4

The TRICARE fiscal year begins on:

A) January 1.
B) July 1.
C) September 1.
D) October 1.

Question 5

The TRICARE Standard annual catastrophic cap (maximum amount beneficiaries are required to pay within 1 year) for retired members' families is:

A) $1,000 per beneficiary.
B) $1,000 per family.
C) $7,500 per beneficiary.
D) $7,500 per family.

Question 6

An individual who qualifies for TRICARE is known as a(n):

A) member.
B) beneficiary.
C) sponsor.
D) enrollee.

Question 7

Under TRICARE, what does NAS stand for?

A) Nonavailability statement
B) Nonactive status
C) Nonauthorized service
D) No available surgeons

Question 8

Authorized TRICARE providers include all of the following EXCEPT:

A) chiropractors.
B) doctors of dental medicine.
C) doctors of optometry.
D) psychologists.

Question 9

Under TRICARE Standard, the group of beneficiaries that pays 25% cost share for outpatient services includes all of the following EXCEPT:

A) former spouses of active-duty service members.
B) retired service members and their families.
C) families of deceased personnel.
D) families of active-duty service members.

Question 10

When a TRICARE beneficiary needs treatment that is NOT available from a military treatment facility (MTF), the:

A) beneficiary will have to pay for the services.
B) services will not be covered.
C) beneficiary must obtain a nonavailability statement (NAS) to receive services from a civilian provider.
D) beneficiary can automatically receive services from a civilian provider.

Question 11

Under TRICARE Standard, the group of beneficiaries that pays 20% cost share for non-network outpatient services includes:

A) former spouses of active-duty service members.
B) families of active-duty service members.
C) families of deceased personnel.
D) retirees from the military.

Question 12

The plan that provides benefits for veterans with 100% service-related disabilities and their families is:

A) TRICARE Standard.
B) TRICARE Extra.
C) TRICARE Prime.
D) CHAMPVA.

Question 13

The TRICARE plan option that provides benefits using a fee-for-service, cost-sharing structure is:

A) TRICARE Standard.
B) TRICARE for Life
C) TRICARE Prime.
D) CHAMPVA.

Question 14

Authorized nonphysician TRICARE providers include all of the following EXCEPT:

A) acupuncturists.
B) audiologists.
C) clinical social workers.
D) speech therapists.

Question 15

If a TRICARE beneficiary receives services from a nonauthorized provider, the physician can bill:

A) only the usual, customary, and reasonable amount.
B) only the authorized contracted amount.
C) only the limiting charge.
D) any amount for the services.

Question 16

To be eligible for TRICARE, all sponsors and family members must be enrolled in DEERS, which stands for:

A) Department Electronic Enrollment Reporting System.
B) Department Early Enrollment Reporting System.
C) Defense Electronic Eligibility Reporting System.
D) Defense Enrollment Eligibility Reporting System.

Question 17

Which of the following services is covered under TRICARE Standard?

A) chiropractic care
B) cosmetic surgery
C) mental healthcare
D) custodial care

Question 18

The TRICARE health maintenance organization (HMO) plan option is:

A) TRICARE Standard.
B) TRICARE Extra.
C) TRICARE Prime.
D) CHAMPVA.

Question 19

Services covered under TRICARE Standard include all of the following EXCEPT:

A) chemotherapy
B) durable medical equipment (DME).
C) mental healthcare.
D) routine physical examinations.

Question 20

An active-duty service member whose family is covered by a TRICARE plan is known as a(n):

A) member.
B) beneficiary.
C) sponsor.
D) enrollee.

Question 21

The TRICARE plan that offers a higher-cost, point-of-service option for care received from out-of-network providers is:

A) TRICARE Standard.
B) TRICARE Extra.
C) TRICARE Prime.
D) CHAMPVA.

Question 22

The TRICARE reform package submitted in 2016 is projected to save TRICARE about:

A) $1 million annually.
B) $10 million annually.
C) $1 billion annually.
D) $6 billion annually.

Question 23

In 1994, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) program name was changed to:

A) the Defense Enrollment Eligibility Reporting System (DEERS).
B) the Veterans Administration (VA) Health Administration Center.
C) TRICARE.
D) CHAMPVA.

Question 24

Under the TRICARE reform in 2018, catastrophic caps for active duty families would be raised to:

A) $1,200.
B) $1,500.
C) $3,000.
D) $4,000.

Question 25

TRICARE beneficiaries older than age 65 are eligible for TRICARE for Life if they have:

A) Medicare Part A coverage.
B) Medicare Part B coverage.
C) Medicare Parts A and B coverage.
D) no Medicare coverage.

Question 26

Under the TRICARE Prime point-of-service option, charges for visits to non-network providers are:

A) not paid by TRICARE.
B) subject to a $6 or $12 copay.
C) paid 80% by TRICARE and 20% by the beneficiary.
D) paid 50% by TRICARE and 50% by the beneficiary.

Question 27

As of October 1, 2016, the TRICARE Prime annual enrollment fee for retired service members is:

A) $0.
B) $282 for an individual or $565 for a family.
C) $300 for an individual or $600 for a family.
D) $520 for an individual or $1,040 for a family.

Question 28

The copay for visits to civilian providers under TRICARE Prime is based on the:

A) type of service required.
B) type of physician providing services.
C) military rank of the sponsor.
D) number of dependent family members.

Question 29

Under TRICARE Prime Remote, referrals to specialists are coordinated by the primary care manager (PCM) and the regional:

A) healthcare finder (HCF).
B) Department of Veterans Affairs (DVA).
C) military treatment facility (MTF).
D) primary care case manager (PCCM).

Question 30

Under the access standards for TRICARE Prime enrollees, appointment wait time for urgent care should NOT exceed:

A) 24 hours.
B) 48 hours.
C) 72 hours.
D) 7 days.

Question 31

Under TRICARE, what does MTF stand for?

A) Medical treatment for forces
B) Military treatment facility
C) Military training families
D) Medical training facility

Question 32

Under TRICARE Prime, the primary care manager provides all of the following services EXCEPT:

A) preventive care.
B) nonavailability statements when required.
C) care for routine illnesses.
D) referral to specialists.

Question 33

Enrollment is NOT required for:

A) TRICARE Standard.
B) TRICARE Prime.
C) TRICARE Prime Remote.
D) CHAMPVA.

Question 34

The cost share for TRICARE Extra enrollees includes a:

A) $0 deductible.
B) $150 deductible for an individual or $300 for a family.
C) $0 deductible and 20% of outpatient charges.
D) $250 deductible for an individual or $500 for a family.

Question 35

TRICARE Prime is a managed care plan that differs from TRICARE Standard in that:

A) beneficiaries are assigned a primary care manager (PCM).
B) more preventive services are covered.
C) fewer out-of-pocket costs must be paid by beneficiaries.
D) All of the above

Question 36

The TRICARE plan with the lowest out-of-pocket costs is:

A) TRICARE Standard.
B) TRICARE Extra.
C) TRICARE Prime.
D) CHAMPVA.

Question 37

Under TRICARE Prime, a PCM is a:

A) primary care manager.
B) physician case manager.
C) preventive care manager.
D) physician consulting manager.

Question 38

If a beneficiary has both TRICARE Senior Prime/TFL and Medicare, which plan is primary?

A) TRICARE is primary.
B) Medicare is primary.
C) The patient can select which is primary.
D) The provider can select which is primary.

Question 39

Under the access standards for TRICARE Prime enrollees, appointment wait time for wellness/preventive care should NOT exceed:

A) 48 hours.
B) 1 week.
C) 2 weeks.
D) 4 weeks.

Question 40

Under the access standards for TRICARE Prime enrollees, appointment wait time for routine care should NOT exceed:

A) 24 hours.
B) 3 days.
C) 7 days.
D) 2 weeks.

Question 41

If a TRICARE Standard beneficiary receives care from a provider who is a nonparticipating provider, he or she is responsible for the provider's additional charges up to 115% of the allowable charge.

Question 42

The claims processor for all TRICARE Senior Prime/TRICARE for Life claims is:

A) Blue Cross/Blue Shield.
B) the Veterans Administration (VA) Health Administration Center.
C) the Wisconsin Physicians Service (WPS).
D) dependent on the location of the provider.

Question 43

Under TRICARE Standard, most enrollees pay an annual deductible but no cost share for outpatient charges.

Question 44

A doctor of osteopathy is considered an authorized service provider for TRICARE.

Question 45

Paper claims for CHAMPVA may be submitted to:

A) Blue Cross/Blue Shield.
B) the Veterans Administration (VA) facility that authorized payment of services.
C) the Wisconsin Physicians Service (WPS).
D) This is dependent on the location of the provider.

Question 46

TRICARE claims are managed in how many separate regions:

A) one.
B) two.
C) thee.
D) four.

Question 47

The TRICARE regional healthcare finder (HCF) provides preventive services and care for routine illnesses or injuries.

Question 48

TRICARE claims must be submitted no later than:

A) 30 days from the date of service.
B) 90 days from the date of service.
C) 6 months from the date of service.
D) 1 year from the date of service.

Question 49

No further family benefits are provided in the event that an active duty military person served from 4 to 6 years and then chose to leave the armed services, thereby giving up a military career.

Question 50

In 2018, TRICARE Senior Prime/TFL beneficiaries will begin paying an annual enrollment fee:

A) set at 5% of gross retired pay.
B) not to exceed $200.
C) set at 1% of gross retired pay.
D) not to exceed $600.

Question 51

Due to confidentiality regulations, TRICARE claims examiners do NOT provide information to parents or guardians of minors in regard to healthcare services that are related to:

A) abortion.
B) alcoholism or drug abuse.
C) sexually transmitted diseases.
D) all of the above.

Question 52

All the following information must appear on the submitted TRICARE claim form EXCEPT:

A) beneficiary's signature.
B) referring physician's name.
C) provider's date of birth.
D) sponsor's social security number.

Question 53

Which claim form must physician offices use to submit claims to TRICARE?

A) CMS-1450
B) CMS-1500
C) UB-04
D) CMS-5100

Question 54

The CHAMPVA program is administered by the:

A) Centers for Medicare and Medicaid Services (CMS).
B) Department of Defense (DoD).
C) Veterans Administration (VA) Health Administration Center.
D) Veterans Administration (VA) hospital network.

Question 55

The TRICARE program covers active-duty service members, retirees, family members, and survivors of eligible armed services members.

Question 56

TRICARE beneficiaries who use nonauthorized providers may be responsible for paying their entire bill.

Question 57

Under TRICARE Prime, visits to civilian network providers require a copayment dependent on the military rank of the sponsor.

Question 58

Under TRICARE Standard, if care is available from a military treatment facility (MTF) but the patient prefers to receive similar care at a civilian facility, he or she can do so after obtaining a nonavailability statement (NAS).

Question 59

If a Veterans Administration (VA) facility cannot provide necessary medical care for a veteran, an authorization for services will specify all of the following EXCEPT the:

A) provider the patient must see.
B) medical services that the VA approves.
C) length of period of treatment.
D) amount the VA will pay.

Question 60

An individual who qualifies for TRICARE coverage is known as a sponsor.

Question 61

CHAMPVA is always the last payer after Medicare and any other health insurance.

Question 62

Charges for visits to providers outside the TRICARE Prime network are paid 50% by TRICARE and 50% by the beneficiary.

Question 63

When the covered beneficiary is responsible for a portion of the total healthcare costs, this is known as cost ________.

Question 64

All armed services sponsors and family members must be enrolled in the ________ Reporting System to be eligible for TRICARE.

Question 65

Contractors who process TRICARE claims do NOT provide information to parents of minors when the healthcare services provided are related to drug abuse.

Question 66

The program that provides medical care for veterans with 100% service-related disabilities is ________.

Question 67

Match the following
The TRICARE plan that is a preferred provider organization (PPO) option

A) TRICARE Prime Remote
B) TRICARE Senior Prime/TRICARE for Life
C) beneficiary
D) nonavailability statement (NAS)
E) CHAMPVA
F) TRICARE Prime
G) TRICARE Standard
H) sponsor
I) TRICARE Extra
J) primary care manager (PCM)

Question 68

Penalties or interest charges can be billed to a beneficiary by a physician due to TRICARE's failure to make payment on a timely basis.

Question 69

The TRICARE plan that is similar to an HMO and requires care to be coordinated by a primary care manager (PCM) is ________.

Question 70

Nonavailability statements are valid for 12 months after they are issued.

Question 71

TRICARE Standard and TRICARE Extra are available to beneficiaries throughout the United States and overseas.

Question 72

If treatment is NOT available at a military treatment facility (MTF), a TRICARE beneficiary must obtain a(n) ________ statement before receiving services from a civilian provider.

Question 73

TRICARE Senior Prime/TRICARE for Life acts as the primary payer when the covered individual also has Medicare coverage.

Question 74

Prescription drug benefits are included in TRICARE Senior Prime/TRICARE for Life.

Question 75

The primary care manager (PCM) under TRICARE Prime may be a single military or civilian provider or a group of providers.

Question 76

A person who is retired from a career in the armed forces is known as a ________ or military retiree.

Question 77

The Department of Defense (DoD) medical entitlement program for uniformed services beneficiaries is ________.

Question 78

Priority access to military treatment facilities (MTFs) is given to TRICARE Standard and TRICARE Extra beneficiaries.

Question 79

Under the TRICARE Prime plan, the provider who coordinates and manages a patient's medical care is referred to as the ________ manager.

Question 80

Active-duty service members who are assigned to permanent duty in a location that is 50 miles or more from sources of military healthcare can obtain services through ________.