Deck 16: Tricare

Question 1

A military treatment facility (MTF) is a health care facility operated by the military that provides inpatient and ambulatory care to eligible TRICARE beneficiaries. Which is an example of ambulatory care?

A) acute care hospital stay
B) emergency department treatment
C) overnight psychiatric evaluation
D) rehabilitation requiring 30-day admission

Answer 1

emergency department treatment

Question 2

Which are located at military treatment facilities to assist beneficiaries in resolving health care collection-related issues?

A) beneficiary counseling and assistance coordinators
B) debt collection assistance officers
C) health care finders
D) nurse advisors

Answer 2

debt collection assistance officers

Question 3

A TRICARE __________ assists primary care providers with preauthorizations and referrals to health care services in a military treatment facility or civilian provider network.

A) beneficiary services representative
B) health care finder
C) nurse advisor
D) primary care manager

Answer 3

health care finder

Question 4

The TRICARE Management Activity (TMA) coordinates and administers the TRICARE program and is accountable for __________ health care provided to members of the uniformed services and their families.

A) affordable
B) efficient
C) pathway
D) quality

Question 5

Commanders of selected military treatment facilities are called __________ for TRICARE regions.

A) beneficiary services representatives
B) health care finders
C) lead agents
D) primary care managers

Question 6

TRICARE __________ are uniformed service personnel who are either active duty, retired, or deceased.

A) beneficiaries
B) patients
C) providers
D) sponsors

Question 7

Which include sponsors and dependents of sponsors?

A) beneficiaries
B) coordinators
C) finders
D) representatives

Question 8

Which are decision-making tools used by providers to determine appropriate health care for specific clinical circumstances?

A) critical pathways
B) living wills
C) practice guidelines
D) revenue management

Question 9

Health Affairs (HA) refers to the Office of the Assistant Secretary of Defense for Health Affairs, which is responsible for __________.

A) military readiness and peacetime health care
B) the military health care system in their region
C) various programs in the civilian health care market
D) working with uniformed service headquarters' staffs

Question 10

Which are located at military treatment facilities and are available to answer questions, help solve health care-related problems, and assist beneficiaries in obtaining medical care through TRICARE?

A) beneficiary counseling and assistance coordinators
B) debt collection assistance officers
C) health care finders
D) nurse advisors

Question 11

TRICARE regions are served by one or more __________ who assist TRICARE sponsors with health care needs and answer questions about the program.

A) military treatment facilities
B) nurse advisors
C) primary care managers
D) service centers

Question 12

TRICARE __________ are available 24/7 for advice and assistance with treatment alternatives and to discuss whether a sponsor should see a provider based on a discussion of symptoms, and they will also discuss preventive care and ways to improve a family's health.

A) beneficiary services representatives
B) health care finders
C) nurse advisors
D) primary care managers

Question 13

The CHAMPUS Reform Initiative (CRI) demonstration project offered military families a choice of how their health care benefits could be used. The DoD noted its successful operation and high levels of patient satisfaction, and determined that its concepts should be expanded to a __________ program.

A) locally operated
B) nationwide uniform
C) regional health care
D) state-by-state

Question 14

Which is a health care program for (1) active duty members of the military and their qualified family members, (2) CHAMPUS-eligible retirees and their qualified family members, and (3) eligible survivors of members of the uniformed services?

A) CHAMPUS
B) CHAMPVA
C) MEDICARE
D) TRICARE

Question 15

Which is the former name for TRICARE Standard?

A) CHAMPUS
B) CHAMPVA
C) DOD-MTF
D) TRIWEST

Question 16

A TRICARE __________ provides information about using TRICARE and assists with other matters affecting access to health care (e.g., appointment scheduling).

A) beneficiary services representative
B) health care finder
C) nurse advisor
D) primary care manager

Question 17

When a patient seeks health care under the TRICARE program, sponsor information is verified in the __________ computer system, which contains up-to-date workforce personnel information.

A) CMS
B) DEERS
C) DOD
D) MTF

Question 18

Which term is used to describe the Army, Navy, Air Force, Marines, and Coast Guard, Public Health Service Commissioned Corps, and the National Oceanic and Atmospheric Administration (NOAA) Commissioned Corps?

A) executive branches
B) government agencies
C) law enforcement
D) uniformed services

Question 19

Which is the sequence of activities that can normally be expected to result in the most cost-effective clinical course of treatment?

A) critical pathway
B) discharge planning
C) pre-certification
D) utilization management

Question 20

Which is the name of the entire health care system of the U.S. uniformed services and includes military treatment facilities as well as various programs in the civilian health care market, such as TRICARE?

A) Defense Enrollment Eligibility Reporting System
B) Military Health Services System
C) TRICARE Program Management Organization
D) TRICARE Service Center

Question 21

The TRICARE benefit that protects beneficiaries from devastating financial loss due to serious illness or long-term treatment by establishing limits over which payment is not required is called the __________ cap benefit.

A) calamitous
B) cataclysmic
C) catastrophic
D) catchment

Question 22

TRICARE enrollees use their uniformed services __________, which can be scanned each time they receive health care services.

A) common access card
B) driver's license
C) insurance ID
D) military badge

Question 23

Which is responsible for the surveillance of fraud and abuse activities worldwide involving purchased care for beneficiaries in the Military Health Care System?

A) Department of Defense
B) Office of Inspector General
C) Program Integrity Office
D) TRICARE management activity

Question 24

Which is assigned to a TRICARE Prime sponsor and is part of the TRICARE provider network?

A) beneficiary services representative
B) health care finder
C) nurse advisor
D) primary care manager

Question 25

Which is a comprehensive health care program for which the Department of Veterans Affairs shares costs of covered health care services and supplies with eligible beneficiaries?

A) CHAMPUS
B) CHAMPVA
C) Medicare
D) TRICARE

Question 26

Which allows TRICARE Standard users to save 5 percent of their TRICARE Standard cost-shares by using health care providers in the TRICARE network?

A) TRICARE
B) TRICARE Extra
C) TRICARE Prime
D) TRICARE Standard Plus

Question 27

TRICARE Prime beneficiaries can receive care if they reside and work outside a military treatment facility __________ area, which is the region defined by code boundaries within a 40-mile radius of a military treatment facility.

A) catchment
B) local
C) regional
D) state

Question 28

Which is the TRICARE managed care option similar to a civilian health maintenance organization?

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

Question 29

Which is issued by a military treatment facility that cannot provide needed care to TRICARE Standard beneficiaries and means the beneficiary can seek care from a civilian provider and reimbursement will be approved?

A) common access card
B) insurance certificate
C) nonavailability statement
D) TRICARE standard letter

Question 30

TRICARE deductibles are applied to the government's __________ year, which runs from October 1 of one year to September 30 of the next.

A) calendar
B) consecutive
C) fiscal
D) sequential

Question 31

Which tests and establishes the feasibility of implementing a new program during a trial period, after which the program is evaluated, modified, and/or abandoned?

A) catchment area
B) demonstration project
C) protocol plan
D) research study