Question 1

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)   $250E) A) and C)
F) A) and B)

Question 2

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

Accepted Answer

A)   insured
B)   sponsor
C)   enrollee
D)   subscriberE) B) and C)
F) All of the above

Question 3

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.E) All of the above
F) B) and C)

Question 4

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.E) A) and D)
F) All of the above

Question 5

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 checkE) B) and C)
F) A) and D) B

Question 6

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)   $5,000E) B) and C)
F) None of the above

Question 7

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

Accepted Answer

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

Question 8

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 disabilityE) A) and B)
F) All of the above

Question 9

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 providersE) A) and B)
F) All of the above

Question 10

Which party is responsible for obtaining preauthorization under CHAMPVA?

Accepted Answer

A)   the PCP
B)   the provider
C)   the patient
D)   the VAE) B) and D)
F) All of the above

Question 11

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 onlyE) C) and D)
F) B) and C)

Question 12

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 paymentE) A) and B)
F) C) and D) A

Question 13

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.E) None of the above
F) B) and D)

Question 14

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 payerE) A) and B)
F) A) and C)

Question 15

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.E) B) and D)
F) B) and C) B

Question 16

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)   MedicareE) All of the above
F) A) and B)

Question 17

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)   TMACE) A) and B)
F) B) and C)

Question 18

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 recipientsE) A) and C)
F) A) and B)

Question 19

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 providerE) None of the above
F) A) and D)

Question 20

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.E) None of the above
F) All of the above

Exam 11: Tricare and 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.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

TRICARE for Life benefits emphasize

Correct AnswerverifiedShow Answer

What must all enrollees in TRICARE for Life do?

Correct AnswerverifiedB

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Who is not eligible for CHAMPVA?

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Which party is responsible for obtaining preauthorization under CHAMPVA?

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedA

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedB

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Where are most CHAMPVA claims submitted?

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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B

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A

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B

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