Deck 14: Tricare and Veterans Health Care

Question 1

The Veterans Health Care Expansion Act of 1973 authorized the

A) CHAMPUS program.
B) CHAMPVA program.
C) TRICARE program.
D) VA program.

Answer 1

CHAMPVA program.

Question 2

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

A) a federal medical care facility.
B) a VA hospital.
C) a U.S. Public Health Service facility.
D) all of the above.

Answer 2

all of the above.

Question 3

TRICARE, formerly known as CHAMPUS, is funded through

A) the U.S. Congress.
B) individual states.
C) individual regions.
D) military contributions.

Answer 3

the U.S. Congress.

Question 4

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

A) PCM.
B) PCP.
C) gatekeeper.
D) HCF.

Question 5

CHAMPVA is a/an

A) insurance program.
B) service benefit program.
C) both a and b.
D) neither a nor b.

Question 6

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

A) PCP.
B) TSC.
C) HCF.
D) PCM.

Question 7

The NAS catchment area is

A) defined by ZIP codes.
B) determined by the availability of hospitals in the area.
C) based on an area of about 40 miles in radius surrounding each USMTF.
D) both a and c

Question 8

The TRICARE fiscal year extends from

A) January 1 to December 31.
B) April 1 to March 31.
C) July 1 to June 30.
D) October 1 to September 30.

Question 9

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

A) within 1 year from the date a service is provided.
B) by the end of the year in which the service is provided.
C) within 1 year from a patient's discharge from an inpatient facility.
D) by the end of the year following a patient's discharge from an inpatient facility.

Question 10

People NOT entitled to benefits under TRICARE are

A) CHAMPVA beneficiaries.
B) dependents of active duty personnel.
C) dependents of service personnel who died in active duty.
D) military retirees.

Question 11

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

A) CHAMPUS
B) Eligibility report
C) TRI-CHECK
D) DEERS

Question 12

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

A) as long as she is not eligible for TRICARE Standard.
B) as long as she is not eligible for Medicare Part A.
C) both a and B
D) neither a nor b.

Question 13

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

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

Question 14

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

A) within 6 months from the date a service is provided.
B) within 1 year from the date a service is provided.
C) by the end of the year in which a service is provided.
D) by the end of the year following the year in which a service is provided.

Question 15

Health care professionals who may treat a TRICARE patient are

A) doctors of medicine.
B) doctors of osteopathy.
C) psychologists.
D) all of the above.

Question 16

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

A) coordination of care.
B) conversion of care.
C) cooperative care.
D) competitive care.

Question 17

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

A) CHAMPUS, CHAMPVA, and TRICARE.
B) military coverage, CHAMPUS, and CHAMPVA.
C) TRICARE Standard, TRICARE Prime, and TRICARE Extra.
D) TRICARE, TRICARE Plus, and TRICARE Premium.

Question 18

Enrollment in TRICARE Prime is for

A) 1 month at a time.
B) 1 year at a time.
C) as long as the beneficiary would like to remain in the plan.
D) none of the above.

Question 19

An NAS is a

A) certification of the status of a military hospital.
B) certification of the status of a civilian hospital.
C) certification from a civilian hospital stating specific treatment that was denied.
D) certification from a military hospital stating that it cannot provide the necessary care.

Question 20

A physician who chooses not to participate in TRICARE bills

A) the total amount of the usual charge.
B) the total amount of the customary charge.
C) no more than 100% of the TRICARE allowable charge.
D) no more than 115% of the TRICARE allowable charge.

Question 21

A certification from a military hospital stating that it cannot provide the care needed is called a ______________________________.

Question 22

Where are claims for patients on active duty sent?

Question 23

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.

Question 24

Who determines eligibility in the CHAMPVA program?

Question 25

Dependents of individuals who have died as a result of service-connected injuries qualify to receive ____________________ benefits.

Question 26

The physician who provides medical care at contracted rates to beneficiaries under the TRICARE Extra program is called a/an ____________________ provider.

Question 27

All dependents ____________________ years of age or older are required to have a Uniformed Services (military) identification card.

Question 28

Individuals who qualify for TRICARE are known as ____________________.

Question 29

The active duty service member whose family members are covered under TRICARE is called the ____________________.

Question 30

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

Question 31

TRICARE Prime and TRICARE Extra claims are

A) filed by the beneficiary to a TRICARE subcontractor.
B) filed by the provider to a TRICARE subcontractor.
C) paid by capitation, so no claim needs to be filed.
D) filed the same as for TRICARE Standard and CHAMPVA claims.

Question 32

What payment does a participating provider agree to accept when assignment is accepted in a TRICARE case?

Question 33

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

A) the last date of service listed on the claim.
B) the date on which the claim was signed.
C) individual time limits for each item on the claim.
D) the date of the first item listed on the claim.

Question 34

What does the Computer Matching and Privacy Protection Act of 1988 permit the government to do?

Question 35

What does the acronym CHAMPVA stand for?

Question 36

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

Question 37

A person who has served in the Armed Forces of the United States, especially in a time of war, who is no longer in the service and has received an honorable discharge is called a/an ____________________.

Question 38

An organization under contract to the government that handles insurance claims for care received under the TRICARE program is known as a/an ____________________.

Question 39

Individuals who qualify for TRICARE are known as subscribers.

Question 40

CHAMPVA's eligibility requirements refer to children as those who are unmarried and younger than the age of ____________________, regardless of whether dependent or not, or up to the age of ____________________ if enrolled in a course of instruction at an approved educational institution.

Question 41

Active duty service members are eligible for TRICARE Extra.

Question 42

Enrollment in TRICARE Prime is voluntary.

Question 43

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

Question 44

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

Question 45

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

Question 46

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

Question 47

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.

Question 48

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

Question 49

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

Question 50

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.

Question 51

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

Question 52

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

Question 53

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