Question 1

Under TRICARE Prime, what payment is required for outpatient treatment at a military facility?

Accepted Answer

A)  there is no deductible or copayment 
B)  a payment for visiting a military facility 
C)  coinsurance 
D)  deductible payment 
A)  there is no deductible or copayment 
B)  a payment for visiting a military facility 
C)  coinsurance 
D)  deductible payment A

Question 2

What must all enrollees in TRICARE for Life do?

Accepted Answer

A)  be enrolled in Medicare Part B only 
B)  be enrolled in Medicare Part A & B and pay Part B premiums 
C)  be enrolled in Medicare Part A only 
D)  have Part A premiums deducted from their Social Security check 
A)  be enrolled in Medicare Part B only 
B)  be enrolled in Medicare Part A & B and pay Part B premiums 
C)  be enrolled in Medicare Part A only 
D)  have Part A premiums deducted from their Social Security check B

Question 3

A fee-for-service plan available to people who have verifiable eligibility through DEERS and who enroll annually is known as

Accepted Answer

A)  Medicaid. 
B)  TRICARE Select. 
C)  TRICARE Prime. 
D)  Medicare. 
A)  Medicaid. 
B)  TRICARE Select. 
C)  TRICARE Prime. 
D)  Medicare. B

Question 4

Patients' out-of-pocket expenses are subject to a catastrophic cap of __________ per calendar year under the CHAMPVA program.

Accepted Answer

A)  $500 
B)  $1,000 
C)  $3,000 
D)  $5,000 
A)  $500 
B)  $1,000 
C)  $3,000 
D)  $5,000

Question 5

Who is not eligible for CHAMPVA?

Accepted Answer

A)  families of active duty members 
B)  survivors of a veteran who died in the line of duty 
C)  dependents of a veteran who is totally and permanently disabled due to a service-connected condition 
D)  survivors of a veteran who died as a result of a service-related disability 
A)  families of active duty members 
B)  survivors of a veteran who died in the line of duty 
C)  dependents of a veteran who is totally and permanently disabled due to a service-connected condition 
D)  survivors of a veteran who died as a result of a service-related disability

Question 6

A nonparticipating provider in TRICARE sees a patient and provides a service with an allowed charge of $200. However, the provider charges the patient $250 for the service. Determine what amount the patient must pay.

Accepted Answer

A)  $230 
B)  $300 
C)  $200 
D)  $250 
A)  $230 
B)  $300 
C)  $200 
D)  $250

Question 7

Identify the two groups brought together by TRICARE to offer increased access to health care services.

Accepted Answer

A)  military hospitals and a network of civilian facilities and providers 
B)  military bases and local hospitals 
C)  a network of Medicaid and Medicare providers 
D)  military hospitals and the Medicare network of providers 
A)  military hospitals and a network of civilian facilities and providers 
B)  military bases and local hospitals 
C)  a network of Medicaid and Medicare providers 
D)  military hospitals and the Medicare network of providers

Question 8

Which party is responsible for obtaining preauthorization under CHAMPVA?

Accepted Answer

A)  the PCP 
B)  the provider 
C)  the patient 
D)  the VA 
A)  the PCP 
B)  the provider 
C)  the patient 
D)  the VA

Question 9

What is the term for the maximum amount TRICARE will pay for a procedure?

Accepted Answer

A)  MTF 
B)  catastrophic cap 
C)  cost-share 
D)  TMAC 
A)  MTF 
B)  catastrophic cap 
C)  cost-share 
D)  TMAC

Question 10

Which of the following is not something that providers who participate with TRICARE agree to?

Accepted Answer

A)  Participate for every patient, every time. 
B)  Appeal claims on behalf of the patient. 
C)  File claims on behalf of patients. 
D)  Accept the TRICARE allowable charge as payment in full for services. 
A)  Participate for every patient, every time. 
B)  Appeal claims on behalf of the patient. 
C)  File claims on behalf of patients. 
D)  Accept the TRICARE allowable charge as payment in full for services.

Question 11

Which of the following examples demonstrates an abuse activity versus a fraudulent one?

Accepted Answer

A)  providing care that is of inferior quality 
B)  altering CPT codes to increase the amount of payment to the provider 
C)  billing more than once for the same service 
D)  changing dates of service, frequency of service, or names of recipients 
A)  providing care that is of inferior quality 
B)  altering CPT codes to increase the amount of payment to the provider 
C)  billing more than once for the same service 
D)  changing dates of service, frequency of service, or names of recipients

Question 12

Who is responsible for the charges if a TRICARE managed care patient visits a provider who chooses not to join the TRICARE network?

Accepted Answer

A)  the patient 
B)  the provider 
C)  TRICARE 
D)  the payer 
A)  the patient 
B)  the provider 
C)  TRICARE 
D)  the payer

Question 13

Who is responsible for the costs of healthcare services not covered by CHAMPVA?

Accepted Answer

A)  No one, CHAMPVA pays 100%. 
B)  the provider, as a write-off 
C)  the beneficiary 
D)  Medicare 
A)  No one, CHAMPVA pays 100%. 
B)  the provider, as a write-off 
C)  the beneficiary 
D)  Medicare

Question 14

When TRICARE for Life beneficiaries receive treatment at a civilian network they must

Accepted Answer

A)  pay a copay. 
B)  make payments toward a deductible. 
C)  pay coinsurance. 
D)  have no deductible or copay. 
A)  pay a copay. 
B)  make payments toward a deductible. 
C)  pay coinsurance. 
D)  have no deductible or copay.

Question 15

Which of the following is the uniformed services member in a family qualified for TRICARE?

Accepted Answer

A)  insured 
B)  sponsor 
C)  enrollee 
D)  subscriber 
A)  insured 
B)  sponsor 
C)  enrollee 
D)  subscriber

Question 16

TRICARE for Life benefits emphasize

Accepted Answer

A)  preventive, wellness, and prescription drug services. 
B)  preventive services only. 
C)  wellness services only. 
D)  prescription drug benefits and wellness services. 
A)  preventive, wellness, and prescription drug services. 
B)  preventive services only. 
C)  wellness services only. 
D)  prescription drug benefits and wellness services.

Question 17

Which of the following services is generally not covered by CHAMPVA?

Accepted Answer

A)  surgical procedures 
B)  dental care 
C)  hospital services 
D)  hospice services 
A)  surgical procedures 
B)  dental care 
C)  hospital services 
D)  hospice services

Question 18

The TRICARE program that offers an HMO-like plan requiring no annual deductible is

Accepted Answer

A)  TRICARE Standard. 
B)  TRICARE Prime. 
C)  TRICARE Reserve Select. 
D)  TRICARE Extra. 
A)  TRICARE Standard. 
B)  TRICARE Prime. 
C)  TRICARE Reserve Select. 
D)  TRICARE Extra.

Question 19

When creating TRICARE patient cases in a PMP, what information is included?

Accepted Answer

A)  the sponsor's grade, branch of service, and status 
B)  the sponsor's grade only 
C)  the sponsor's status and grade 
D)  the sponsor's branch of service only 
A)  the sponsor's grade, branch of service, and status 
B)  the sponsor's grade only 
C)  the sponsor's status and grade 
D)  the sponsor's branch of service only

Question 20

Where are most CHAMPVA claims submitted?

Accepted Answer

A)  the regional CHAMPVA claims processing center 
B)  the centralized CHAMPVA claims processing center 
C)  with the participating provider 
D)  with the primary care provider 
A)  the regional CHAMPVA claims processing center 
B)  the centralized CHAMPVA claims processing center 
C)  with the participating provider 
D)  with the primary care provider

Under TRICARE Prime, what payment is required for outpatient treatment at a military facility?

What must all enrollees in TRICARE for Life do?

A fee-for-service plan available to people who have verifiable eligibility through DEERS and who enroll annually is known as

Patients' out-of-pocket expenses are subject to a catastrophic cap of __________ per calendar year under the CHAMPVA program.

Who is not eligible for CHAMPVA?

A nonparticipating provider in TRICARE sees a patient and provides a service with an allowed charge of $200. However, the provider charges the patient $250 for the service. Determine what amount the patient must pay.

Identify the two groups brought together by TRICARE to offer increased access to health care services.

Which party is responsible for obtaining preauthorization under CHAMPVA?

What is the term for the maximum amount TRICARE will pay for a procedure?

Which of the following is not something that providers who participate with TRICARE agree to?

Which of the following examples demonstrates an abuse activity versus a fraudulent one?

Who is responsible for the charges if a TRICARE managed care patient visits a provider who chooses not to join the TRICARE network?

Who is responsible for the costs of healthcare services not covered by CHAMPVA?

When TRICARE for Life beneficiaries receive treatment at a civilian network they must

Which of the following is the uniformed services member in a family qualified for TRICARE?

TRICARE for Life benefits emphasize

Which of the following services is generally not covered by CHAMPVA?

The TRICARE program that offers an HMO-like plan requiring no annual deductible is

When creating TRICARE patient cases in a PMP, what information is included?

Where are most CHAMPVA claims submitted?

Introduction to the Medical Billing Cycle

Electronic Health Records, Hipaa, and Hitech: Sharing and Protecting Patients Health Information

Patient Encounters and Billing Information

Diagnostic Coding: Introduction to ICD-10-CM

Procedural Coding: CPT and HCPCS

Visit Charges and Compliant Billing

Health Care Claim Preparation and Transmission

Private Payers/BlueCross BlueShield

Medicare

Medicaid

Workers Compensation and Disabilityautomotive Insurance

Payments Ras, Appeals, and Secondary Claims

Patient Billing and Collections

Hospital Billing and Reimbursement

CPT and HCPCS

Filters

Exam 11: Tricare and Champva

Under TRICARE Prime, what payment is required for outpatient treatment at a military facility?

What must all enrollees in TRICARE for Life do?

A fee-for-service plan available to people who have verifiable eligibility through DEERS and who enroll annually is known as

Patients' out-of-pocket expenses are subject to a catastrophic cap of __________ per calendar year under the CHAMPVA program.

Who is not eligible for CHAMPVA?

A nonparticipating provider in TRICARE sees a patient and provides a service with an allowed charge of $200. However, the provider charges the patient $250 for the service. Determine what amount the patient must pay.

Identify the two groups brought together by TRICARE to offer increased access to health care services.

Which party is responsible for obtaining preauthorization under CHAMPVA?

What is the term for the maximum amount TRICARE will pay for a procedure?

Which of the following is not something that providers who participate with TRICARE agree to?

Which of the following examples demonstrates an abuse activity versus a fraudulent one?

Who is responsible for the charges if a TRICARE managed care patient visits a provider who chooses not to join the TRICARE network?

Who is responsible for the costs of healthcare services not covered by CHAMPVA?

When TRICARE for Life beneficiaries receive treatment at a civilian network they must

Which of the following is the uniformed services member in a family qualified for TRICARE?

TRICARE for Life benefits emphasize

Which of the following services is generally not covered by CHAMPVA?

The TRICARE program that offers an HMO-like plan requiring no annual deductible is

When creating TRICARE patient cases in a PMP, what information is included?

Where are most CHAMPVA claims submitted?

Introduction to the Medical Billing Cycle

Electronic Health Records, Hipaa, and Hitech: Sharing and Protecting Patients Health Information

Patient Encounters and Billing Information

Diagnostic Coding: Introduction to ICD-10-CM

Procedural Coding: CPT and HCPCS

Visit Charges and Compliant Billing

Health Care Claim Preparation and Transmission

Private Payers/BlueCross BlueShield

Medicare

Medicaid

Workers Compensation and Disabilityautomotive Insurance

Payments Ras, Appeals, and Secondary Claims

Patient Billing and Collections

Hospital Billing and Reimbursement

CPT and HCPCS

Filters