Each region is headed by an individual who is responsible for oversight of all healthcare delivery activities within his or her region and is called a:
The main purpose of the TRICARE Management Activity (TMA) is to:
Enhance the performance of TRICARE worldwide
The computerized data bank that lists all active and retired military service members is called:
The fee-for-service option offer by TRICARE, which has basically the same benefits as the original CHAMPUS program, is:
CHAMPVA eligibility can be lost if certain demographic changes occur, such as:
A widow remarrying, Divorcing the sponsor, Becoming eligible for Medicare. (all the above)
CHAMPVA is the last payer after all other third-party payers have met their obligations except for:
Medicaid, CHAMPVA supplemental insurance (d. a and b are correct)
TRICARE Prime is a health maintenance organization-type managed care option in which MTFs are the principal source of healthcare
Under TRICARE Prime's point of service (POS) option, enrollees are allowed to receive healthcare services only from providers within the POS network.
Under TRICARE FOR LIFE,TRICARE pays Medicare deductibles and coinsurance or copayment amounts up to 115% of Medicare-allowable charges
TRICARE participating providers (PARS) must accept the TRICARE allowable charge as payment in full for the healthcare services provided and cannot balance bill.
In the case of nonparticipating providers (nonPARs), TRICARE Standard patients must file their own claims; however, the reimbursement check is sent to the provider
Even though electronic claims submission is preferred by most major carriers, military carriers still prefer paper claims
The federal program that establishes workers' compensation for nonmilitary federal government employees is known by the acronym:
The federal program that establishes workers' compensation for railroad workers engaged in interstate commerce is known by the acronym:
An individual responsible for investigating and resolving workers' complaints against the employer or insurance company that is denying the benefits is called a(n):
Individual state statutes
The time limit for filing a workers' compensation claim is established by:
Time limits vary from state to state
An injury or illness that is job related typically must be reported to the employer:
A patient's inability to perform normal job duties at the previous level of expertise as a result of being absent from work is called:
Progress reports, Supplemental reports (d. a and b)
After the initial attending physician report has been filed, periodic updates must be provided to the employer/insurer, called:
The type of insurance that replaces a portion of earned income when an individual is unable to perform the requirements of his or her job because of non-job-related injury or illness is called:
A benefit cap
The maximum amount of benefits that can be received in a specific time period is called:
Americans with Disabilities Act (ADA)
The federal act established in 1990 that protects the civil rights of individuals with disabilities is called the:
State Disability Determination unit
The examining body that determines if an applicant qualifies for SSDI is the:
Financial means test
The method of determining whether or not an individual is eligible for SSI benefits is through a(n):
Ticket to Work
The program that provides greater choice in selecting the providers and rehabilitation services disabled individuals need to help them keep working or return to work is called:
Employers must purchase workers' compensation policies from the state in which their business operates.
In the United States, any employee who is injured on the job or develops an employment-related illness that prevents the individual from working is likely to be eligible to collect workers' compensation benefits.
If an employee is injured on the job, the employer can be penalized if the cause of injury or illness was due to the employer being conspicuously negligent.
Most state workers' compensation laws include coverage for injuries sustained while an employee is commuting to and from work.
If a workers' compensation claim is denied, the worker may file a claim with his or her health insurance carrier only after all workers' compensation appeals have been exhausted.
Workers' compensation patients are not required to sign a release of information form for a claim form to be filed.
An individual may receive benefits from only one federal disability program even if he or she meets all the eligibility requirements for several.
The SSI program provides monthly cash payments to low-income aged, blind, and disabled individuals.