Ch 10: True and False

Question 1

T/F: The sponsor’s relationship to the beneficiary creates eligibility under TRICARE

Answer 1

True

Question 2

T/F: Military retirees and their family members are not eligible for TRICARE

Answer 2

False

Question 3

T/F: TRICARE pays for “allowed” services, supplies, and procedures only

Answer 3

True

Question 4

T/F: There is no “cost sharing” under TRICARE regulations

Answer 4

False

Question 5

T/F: Active duty, guard, and reserve members are automatically enrolled in TRICARE Standard

Answer 5

False

Question 6

T/F: TRICARE coverage is lost when a sponsor separates from active duty

Answer 6

True

Question 7

T/F: Although TRICARE healthcare benefits are broad, there is no dental coverage available

Answer 7

False

Question 8

T/F: OHI does not include TRICARE suppemental insurance of Medicaid

Answer 8

True

Question 9

T/F: Under TRICARE for Life, TRICARE pays Medicare deductibles and coinsurance or copayment amounts up to 115% of Medicare-allowable charges

Answer 9

True

Question 10

T/F: Eligibility for patients claiming TRICARE and CHAMPVA coverage should be verified immediately

Answer 10

True

Question 11

T/F: Every TRICARE-eligible ADSM, family member older than age 10, and retiree must have a Common Access Card (CAC), uniformed services identification (ID) card, or eligibiliry authorization letter

Answer 11

True

Question 12

T/F: TRICARE participating providers (PARs) must accept the TRICARE allowable charge as payment in full for the healthcare services provided and cannot balance bill

Answer 12

True

Question 13

T/F: Patients using TRICARE Standard may be responsible for submitting their own claims

Answer 13

True

Question 14

T/F: In the case of nonparticipating providers (nonPARs), TRICARE Standard patients must file their own claims; however, the reimbursement check is sent to the provider

Answer 14

False

Question 15

T/F: TRICARE claims must be submitted electronically without exception

Answer 15

False

Question 16

T/F: The deadline for submitting military claims varies from region to region

Answer 16

False

Question 17

T/F: When an individual becomes eligible for CHAMPVA, he or she is guaranteed coverage for life

Answer 17

False

Question 18

T/F: There is no cost to CHAMPVA beneficiaries when they receive healthcare treatment at a VA facility

Answer 18

True

Question 19

T/F: CHAMPVA eligibles may see any provider they choose as long as the provider is appropriately licensed

Answer 19

True

Question 20

T/F: CHAMPVA is always the payer of last resort

Answer 20

False

Question 21

T/F: CHAMPVA beneficiaries have no cost-sharing requirements

Answer 21

False

Question 22

T/F: When a beneficiary is eligible for healthcare benefits under both Medicare an CHAMPVA, Medicare is the primary payer

Answer 22

True

Question 23

T/F: Both PAR and nonPAR providers must accept CHAMPVA’s allowable rate and cannot balance bill

Answer 23

False

Question 24

T/F: Both PAR and nonPAR providers are required to submit claims on behalf of CHAMPVA beneficiaries

Answer 24

False

Question 25

T/F: All CHAMPVA appeals should be in writing

Answer 25

True