34 Questions
What is the primary role of the beneficiary counseling and assistance coordinator?
They are a beneficiary advocate and problem solver, providing dedicated service to all Military Health System (MHS) beneficiaries.
Who should the BCAC work with to provide enrollment, benefit, and claims processing?
Functional experts.
What is the primary purpose of the DCAO?
To determine the validity of collection agent claims and negative credit reports received for debts incurred because of medical and dental care under the TRICARE program.
For a case to qualify as a debt collection case, what must be presented to the DCAO?
Letter from a Collection Agency indicating that the beneficiary has been sent to collection for non-payment partial payment or denial of claim for services of a TRICARE-associated claim, and/or a negative credit report secondary to the above.
The _______ requires that all active duty personnel attend in-and out-processing programs and that these programs include information on TRICARE benefits.
A ____________ brief ensures that all members departing PCS obtain the most up-to-date information regarding the TRICARE benefit.
What are some things that should be passed on to the gaining MTF?
Recent identification and/or clinical management efforts to control chronic disease condition, poorly controlled chronic disease conditions requiring regular, uninterrupted follow-up, current pregnancy or medical diagnoses requiring obstetrics follow-up, newborns with follow-up requirements, pending radiographic, laboratory, and pathologic specimens, and pending/incomplete referrals or referrals where a result has not been obtained
What is the National Defense Authorization Act?
The Senate and House “instructions" to the DOD to change, add, or eliminate programs.
In the NDAA, what Title addresses health concerns?
Title VII, Healthcare Provision
What are some factors that may affect implementation dates?
Funding, public reviews/comments, contract awards, and additional policy.
From the text, what is an example of data driven decisions?
Checking the weather in the morning to see if you need a jacket or umbrella, or going to see movies by considering the reviews and finding out what time a specific movie is playing.
What does the MHS use to assist with day-to-day activities?
Real time, or near real time, operational systems.
What is health informatics?
It is the study of resources and methods for managing health information.
What three basic elements describe the TRICARE Operations Center (TOC)?
Get data, process data, and display data
What report answers “how many appointments were left unbooked?”
The Access to Care Appointment Utilization Report.
What are the categories the data metrics website is divided in to?
Ambulatory metrics, inpatient metric, clinical coding reports, DQ reports, World Wide Report metrics, and Online help Documents Ambulatory Data Management
What reports are available within the Ambulatory Data Management (ADM) module in Composite Health Care System (CHCS)?
Appointments with no ADM records by clinic, ADM patients with third party insurance, ADM compliance, ADM records with unresolved coding issues and interface transmission status of ADM record
______________ is a system that produces various non-standard reports that are not necessarily run on a consistent basis.
MTF commanders establish resource-sharing agreements with ____________.
What can the Manage Care Support (MCS) contractor provide through resource sharing?
Personnel, equipment, equipment maintenance, and supplies
What allows the MCS contractor, through agreements with MTF commanders, to provide personnel, equipment, equipment maintenance, and supplies necessary to enhance the capability of the MTF to provide healthcare to TRICARE beneficiaries?
Resource sharing.
_____________ is an alternative to resource sharing which provides additional flexibility to MTF commanders.
_______________ make a good faith effort to work with the contractor to execute sound resource sharing agreements.
Why does the TRICARE regional offices (TRO) perform periodic reviews of MTF and VA facility resource sharing agreements?
To ensure compatibility with agreements including VA facilities as network providers
What acts and amendments must medical personnel comply with?
The Privacy Act, FOIA, HIPAA, Drug Abuse Offense and Treatment act, and Comprehensive Alcohol Abuse amendments.
What is PII the acronym for?
PII is Personally Identifiable Information
Medical records are maintained within a system of records protected by which act?
The Privacy Act
___________ eliminates the need for a separate privacy act statement for each medical or dental document?
Relative to the release of medical information, what is the purpose of the DD Form 2005?
It serves as evidence that, as prescribed by the privacy act, the individual was informed of the purpose and uses of the information collected and was advised of his/her rights and obligations when providing their data.
What must a Freedom of Information Act (FOIA) request contain?
It must be in writing and must reasonably describe the record(s) the individual is looking for and it must indicate a willingness to pay fees associated with processing.
The _______________ laws take precedence over other directives pertaining to access and release of medical information.
Whenever you release information under the guidelines of the drug and alcohol abuse acts, what statement must accompany the disclosure?
“Prohibition on Redisclosure: This information has been disclosed to you from records whose Confidentiality is protected by federal law. Federal regulations prohibit you from making any further Disclosure of this information without the specific written consent of the person to whom it pertains. A General authorization for the release of the medical or other information is not sufficient for this purpose.”
To improve the portability and continuity of health insurance coverage, improve access to long-term care services and coverage, and simplify the administration of healthcare is the purpose of _______
List the six requirements of the HIPPA Privacy Rule.
(1) Use of information, (2) acknowledgement of notice of privacy practices, (3) disclosure or release, (4) patient rights to access,(5) accounting of disclosure, and (6) restrictions on information.
Test your knowledge of TRICARE enrollment, benefits, and claims processing with this quiz. Explore the roles of the beneficiary counseling and assistance coordinator (BCAC) and the debt collection assistance officer (DCAO) in providing essential support to military personnel.
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