ANSWERS TO EXERCISES IN TEXTBOOK - Chapter 11

ANSWERS TO THINKING IT THROUGH

Thinking It Through 11.1 page 382

1. The most current information will be available on the website for the TRICARE program and also by asking the sponsor to contact DEERS if the patient’s eligibility for coverage is being verified.

Thinking It Through 11.2 page 384

1. Students answers will vary, but they should recognize that medical insurance specialists should make sure that they learn the appropriate steps they need to take to ensure compliance. If necessary, they should contact their local MTF for information, ask questions of their co-workers, and create self-check lists as needed.

Thinking It Through 11.3 page 387

1. Students should review the information at the website and be prepared to discuss it.

Thinking It Through 11.4 page 388

1. TRICARE for Life allows an individual to continue receiving treatment at a military facility, so treatment from the same provider(s) can be continued, and there is no cost-share for inpatient or outpatient visits to a military treatment facility. In a Medicare HMO, the individual would be required to change providers and would most likely pay coinsurance when receiving outpatient or inpatient services.

ANSWERS TO REVIEW QUESTIONS

Matching page 396

1. C

2. A

3. D

4. J

5. I

6. E

7. L

8. N

9. M

10. K

11. H

12. B

13. F

14. G

Multiple Choice page 397

1. A

2. A

3. C

4. A

5. B

6. B

7. D

8. A

9. D

10. D

Completion Page 397

1. The purpose of the TRICARE program is to bring the resources of military hospitals together with a network of civilian facilities and providers to offer increased access to health care services for military personnel and their families.

2. The order of priority in a military treatment facility is (1) active-duty service members, (2) TRICARE Prime enrollees, (3)TRICARE Extra enrollees, (4) TRICARE Standard enrollees.

ANSWERS TO APPLYING YOUR KNOWLEDGE pages 398-401

Cases 11.1, 11.2, and 11.3 require claim completion. Students may complete paper CMS-1500 forms by hand or by using the electronic CMS-1500 form. They may also use the simulated Medisoft Connect Plus exercises to create and print the claims. The claim case answer keys provided in this Instructor’s Manual are based on completion of paper CMS-1500 claim forms using the electronic form.

Case 11.1

Case 11.2

Case 11.3