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Medical Insurance chapter 16
Terms in this set (41)
Who manages each TRICARE region and is responsible for the military health system in that region?
Which was a demonstration project carried out in California and Hawaii that offered military families a choice of how their health care benefits could be used?
CHAMPUS Reform Initiative
The lead agent staff serves as a federal health care team created to work with regional military treatment facility commanders, uniformed service headquarters' staffs, and Health Affairs (HA) to support the mission of the:
Military Health Services System
Which refers to the Office of the Assistant Secretary of Defense for Health Affairs, which is responsible for both military readiness and peacetime health care?
(HA) Health Affairs
Which is a registered nurse or physician assistant who assists primary care providers with preauthorizations and referrals?
health care finder
Where can TRICARE sponsors find beneficiary services representatives and health care ﬁnders for assistance with health care needs and answers to questions about the program?
TRICARE Service Centers
Which is responsible for surveillance of TRICARE fraud and abuse activities?
Program Integrity Office (PI)
Uniformed service personnel who are active duty, retired, or deceased beneficiaries of TRICARE are called:
Where may Defense Department personnel information be found for sponsor information verification?
Defense Enrollment Eligibility Reporting System (DEERS)
TRICARE beneficiaries include:
sponsors and dependents of sponsors
Of the three TRICARE options, which option is the fee-for-service model?
The sequence of activities that can normally be expected to result in the most cost-effective clinical course of treatment is called a:
Which are located at MTFs and are available to answer questions, help solve health care-related problems, and assist beneficiaries in obtaining medical care through TRICARE?
beneficiary counseling and assistance coordinators
Which are located at military treatment facilities to assist beneficiaries in resolving health care collection-related issues?
debt collection assistance officers
Which 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?
Which are decision-making tools used by providers to determine appropriate health care for specific clinical circumstances?
Which protects TRICARE beneficiaries from devastating financial loss due to serious illness or long-term treatment by establishing limits over which payment is not required?
catastrophic cap benefit
NAS certificates are not required for:
A certificate issued by a military treatment facility (MTF) when necessary services or care cannot be provided is a(n):
How many miles is the radius of a military treatment facility's catchment area?
Of the three TRICARE options, which provides comprehensive health care benefits with the lowest out-of-pocket costs?
TRICARE Extra members save _____ percent of their TRICARE Standard cost-shares by using health care providers in the TRICARE network.
To receive TRICARE Extra services, enrollees must present their uniformed services common access card (CAC), which is issued by the:
Department of Defense
October 1 to September 30 reflects the government's:
The health care program for active duty members of the military and their qualified dependents is called
Which office coordinates and administers the TRICARE program and is accountable for the quality of health care provided to members of the uniformed services and their eligible dependents?
TRICARE Management Activity (TMA)
Who assists TRICARE sponsors with information about the health program, along with other matters affecting access to health care (e.g., appointment scheduling)?
beneficiary services representative (BRS)
The managed care option that is similar to a civilian HMO is called TRICARE
CHAMPUS was replaced by TRICARE
TRICARE nonparticipating providers are subject to a limiting charge of _____ above the TRICARE fee schedule for participating providers.
What is the abbreviation for the computer system that contains up-to-date Defense Department workforce personnel information and is used to verify TRICARE eligibility?
The number of TRICARE regions has _____ since originally established.
A doctor assigned to a sponsor and is part of the TRICARE provider network.
primary care manager (PCM)
TRICARE Prime beneficiaries also receive care if they reside and work outside an MTF ___________ , the region defined by code boundaries within a 40-mile radius of an MTF
TRICARE Management Activity (TMA) is the office that coordinates and administer the TRICARE progaram and is accountable for __________ health care provided to members of the uniformed services and their famiies
The Transitional Assistance Management Program (TAMP) provides _________ days of premium free transitional health care benefits after regular TRICARE benefits end
Military Treatment Facility (MTF) is a health care facility operated by the military that provides inpatient and/or ambulatory _________ care to eligible TRICARE beneficiaries
outpatient and emergency department
U.S. military branches that include the Army, Navy, Air Force, Marines, Coast Guard, Public Health Service, and the North Atlantic Treaty Organization (NATO).
TRICARE has established a _______ for assigned claim when the copy of the front and back of the patient's uniformed services common access card on file turns out to be invalid.
"good faith policy"
A _____________ test and establishes the feasibility of implementing a new program during a trail period
demonstration project or pilot
a research study that helps find ways to prevent, diagnose, or treat illnesses and improve health care is called;
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