Under TRICARE Prime, the primary care manager provides all of the following services EXCEPT:
preventive care.
nonavailability statements when required.
care for routine illnesses.
referral to specialists.
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Q. 2) The first level of Medicare appeals is a request for:
review by a qualified independent contractor.
redetermination by the carrier.
review by an administrative law judge.
review by the state insurance commissioner.
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Q. 3) What is the penalty for workers' compensation fraud?
What will be an ideal response?
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Q. 4) What is peer review?
What will be an ideal response?
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Q. 5) The Medicare document that patients sign to authorize the release of information for claims processing and payment is the __________ Claim Authorization and Information Release form.
Fill in the blank with correct word.
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Q. 6) If no payment is made on a claim by the carrier because the patient has NOT yet satisfied the deductible:
an EOB is sent to the patient only.
an EOB is sent to the provider only.
an EOB is sent to both the patient and the provider.
no EOB is sent.
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Q. 7) Hospitals are NOT permitted to submit interim claims for Medicaid patients while they are still hospitalized.
Indicate whether this statement is true or false.
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Q. 8) Providers participating in Medicaid must accept the Medicaid payment rate as payment in full and cannot balance-bill the patient.
Indicate whether this statement is true or false.
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Q. 9) Medicare carriers must process a redetermination within:
30 days.
60 days.
90 days.
180 days.
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Q. 10) If a Medicaid patient is on restricted status when eligibility is verified, the patient is required to:
receive only certain services.
receive services only from a specific provider.
obtain authorization for all services.
obtain services only in cases of an emergency.
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