Volume 3 Flashcards

(62 cards)

0
Q

What is composed of time slots that have been assigned appropriate appointment types, durations, and a maximum number of patients per slot?

A

Schedule

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1
Q

The manage access to care (ATC) tools are available in the CHCS and are also located on the web at the

A

TRICARE Operations Center

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2
Q

What is a pattern of time slots specific to a provider, but not linked to any particular date?

A

Template

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3
Q

What schedule in the CHCS makes it simple for you to add, delete, cancel, freeze, and release schedule time slots for specific days within any provider’s schedule?

A

Maintain/Cancel

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4
Q

Which CHCS option allows you to cancel all or parts of an existing schedule at the request of the provider or another agency at the medical treatment facility?

A

Cancelled by Facility

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5
Q

What includes all units, organizations, and members of the Air National Guard and the Air Force Reserve?

A

Air Reserve Component

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6
Q

The favorable dependency determination must specifically state the individual is eligible for medical care and this eligibility determination is made by the

A

Military personnel flight (MPF)

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7
Q

The former CHAMPUS option that pays a share of the cost of covered healthcare services you obtain from an authorized, non-network, civilian healthcare provider is

A

TRICARE Standard

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8
Q

Pregnant females discharged under other than honorable conditions who must be authorized by a general court-martial authority to apply to the medical group commander for obstetrical care, fall within what program?

A

Secretary of the Air Force Designee

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9
Q

Children retain their eligibility unless the marry before the age of

A

21

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10
Q

Active duty service members’ family members not enrolled in TRICARE Prime belong in priority group

A

Four

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11
Q

When applying the general rules, what priority group include special provisions applicable to military members who are not on active duty, but are entitled to care in the medical treatment facility?

A

One

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12
Q

When creating a personal master schedule, the appointment personnel must coordinate with the

A

Provider

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13
Q

To be cognizant of the information you are inputting into the system, you must remember what?

A

Accuracy and effectiveness ensure the report is good

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14
Q

When you print reports by using the appropriate options, and enter the necessary report, and print parameters what will happen next?

A

On-demand reports will print

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15
Q

For preventive health assessment (PHA) reasons, how often are members’ records reviewed to ensure all requirements and recommendations have been addressed?

A

Annually

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16
Q

The function that ensures the preventive individual medical readiness program is evaluated during operational readiness inspections (ORI), MAJCOM-level staff assistance visits, and health services inspections (HIS) and JCAHO inspections is

A

MAJCOM SG

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17
Q

Who is required to conduct medical record reviews in order to identify significant items of medical history and any information that may be potentially disqualifying for deployment or worldwide duty?

A

Primary care element (PCE) and primary care management (PCM) teams

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18
Q

MTF use what two data systems to identify and describe their enrolled population by age, gender, and beneficiary category, and to assess their healthcare needs?

A

DoD and Air Force Medical Service (AFMS)

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19
Q

What non-electronic, folder-style form documenting immunizations is used by all active duty, reserve, and Air National Guard personnel?

A

DD Form 2766, Adult Preventive and Chronic Care Flowsheet

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20
Q

What process for inpatients begins before or on admission and continues after appropriate discharge to include follow-up and evaluation of services provided?

A

MTF Discharge and Disposition Planning Process (DCP)

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21
Q

What MTF process is a broad-spectrum scope and approach to identify beneficiaries experiencing conditions which may indicate the need for case management services?

A

MTF Case Management Process

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22
Q

At least how often must MTF assess centrally and locally produced performance measures for effectiveness and efficiency?

A

Quarterly

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23
Q

What federal government’s healthcare financing for the elderly is called

A

Medicare

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24
When legislation was passed enabling managed care plans to increase in numbers and expand enrollments through healthcare programs financed by grants, contracts, and loans, which of the following was the name?
Health Maintenance Organization Act of 1973
25
If a healthcare system is responsible for both the financing and delivery if a broad range of comprehensive health services to a voluntary enrolled population, what plan would apply?
HMO
26
If an individual is enrolled in a healthcare plan, who is responsible for reimbursing covered individuals for the cost of their healthcare?
Health care insurance companies
27
If a patient has routine medical needs, who would be the patient's principal provider?
Primary Care Manager
28
What was formerly known as the Pubic Health Services Hospitals, and now operates much like TRICARE Prime?
Uniformed Services Family Health Plan
29
What is the main challenge for most eligible beneficiaries?
Deciding what TRICARE option is best for their particular situation
30
The TRICARE program is geographically structured by
Regions
31
How many regions are there within TRICARE?
3
32
Within each local delivery area, how is TRICARE health care managed?
Locally
33
The benefits of TRICARE cannot be fully realized without timely informant regarding access, utilization and
Costs
34
For at least how many months is the enrollment period for TRICARE Prime?
12
35
Currently TRICARE Standard pays what percentage of the approved or allowable cost for outpatient care, for active duty families, after the annual deductible is paid?
80
36
TRICARE Plus enrollment is noted on beneficiary records in
DEERS
37
TRICARE Standard has
The broadest choice of providers
38
What document reflects a reasoned and balanced approach to managing the military health benefit with military medical readiness as a first priority?
TRICARE governance plan
39
The TRICARE Regional Office (TRO) operates under the authority, direction, and control of the
Regional director
40
One of the most important functions of manages care support (MCS) contractor is the development of civilian provider networks in support of TRICARE
Prime and Extra benefits
41
What does the TRICARE Regional Office use as the baseline to build additional network needs, develop referral policy and measure access standards?
Primary care system
42
Which duty is performed by the administrative contracting officer (ACO)?
Assists with resolving contractual issues
43
Who is each TRICARE Regional Office (TRO) and MTF required to have available to assist beneficiaries in determining the validity of collection agent claims received for debts incurred as a result of medical/dental care under the TRICARE Program?
DCAO
44
A nonenrolled beneficiary is required to obtain authorization for care from the Health Care Finder (HCF) when
A NAS is required
45
Non availability statements (NAS) are processed through the
DEERS
46
There is no copayment or deductible for beneficiaries referred for civilian medical care
While in a inpatient status in the MTF
47
Who authorizes non- MTF Referred Supplemental Care for the uniformed services?
SPOC
48
The TRICARE Management Activity (TMA) is a field activity of the
Undersecretary of Defense for Personnel and Readiness
49
Who, along with the TRICARE Regional Offices, are responsible for conducting provider training on TRICARE and managed care in accordance with contract provisions?
MCS contractors
50
Who is responsible for oversight of the managed care support (MCS) contractor's marketing programs?
Regional TROs
51
TRICARE presentations are most effective when done jointly by a knowledgeable uniformed representative and a
MCSC marketing representative office
52
What should be the first priority in developing marketing material for a region?
Enrollment packages
53
The Customer Satisfaction Survey primarily attempts to collect information regarding
A specific appointment
54
When utilizing resource support, who may request a task order for personnel equipment, equipment maintenance, and supplies?
MTF commander
55
Whose policy requires you to consider resource sharing agreements are in the best interest of the government and are in support of the regional healthcare plan?
TRICARE
56
Who determines whether or not resource sharing agreements are in the best interest of the government and are in support of the regional health care plan?
TROs
57
Who establishes the resource sharing agreements with the managed care support contractor (MCSC)?
MTF commander
58
Who performs periodic reviews of the MTF/VA facility resource sharing agreements to ensure compatibility with agreements including VA facilities as network providers?
TRO
59
As a minimum, the medical portion of in-and-out processing should include information on how access health care at the MTF and in the community, and how to
Resolve problems accessing health care
60
Active duty personnel who have family members may or may not elect to enroll their family in
TRICARE Prime
61
Which office conducts the required medical out-processing briefing?
TRICARE office