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Chapter 13 & 14

STUDY
PLAY
Which of the following is an aid program under Medicare for low-income patients?
Medicaid Qualified Medicare Beneficiary Program, Specified Low-Income Medicare Beneficiary Program, Qualifying Individuals Program
When a Medicaid patient has Medicare, TRICARE, or CHAMPVA, Medicaid should be billed
second
Though the time limit to appeal a claim varies from state to state, generally an appeal must be filed within
30-60 days.
Conditions that do NOT qualify children for the Maternal Child Health Program in all states participating in Medicaid include
epilepsy
TRICARE claims must be billed on a special claim form provided by the closest military facility within the area of treatment
False
A partnership program permits TRICARE-eligible people to receive inpatient treatment from civilian providers of care in a military hospital.
True
Providers may choose to accept TRICARE assignment on a case-by-case basis
True
A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries
True
The time limit within which a TRICARE outpatient claim must be filed is
within 1 year from the date a service is provided
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
PCM
TRICARE/CHAMPVA is usually the second payer when a beneficiary is enrolled in other health insurance plans.
True
The Veterans Health Care Expansion Act of 1973 authorized the
CHAMPVA program.
TRICARE is subject to state regulatory agencies that control insurance policies.
False
What is the system called that TRICARE claims processors use to verify beneficiary eligibility?
DEERS
The health maintenance organization provided for dependents of active duty military personnel is called
TRICARE Prime
The time limit within which a TRICARE inpatient claim must be filed is within
1 year from a patient's discharge from an inpatient facility.
The three choices of health care coverage for families of active duty military personnel, military retirees, and their dependents are
TRICARE, TRICARE Plus, and TRICARE Premium.
TRICARE, formerly known as CHAMPUS, is funded through
Congress.
Enrollment in TRICARE Prime is voluntary
True
A person retired from a career in the Armed Forces is eligible for TRICARE until 65 years of age.
True
An NAS is a
certification from a military hospital stating that it cannot provide the necessary care.
People NOT entitled to benefits under TRICARE are
CHAMPVA beneficiaries.
The Privacy Act of 1974 establishes an individual's right to review his or her medical records maintained by a
federal medical care facility, VA hospital, U.S. Public Health Service facility