HCM 425 FINAL EXAM QUESTIONS
AND ANSWERS ALL CORRECT
Which is a function of the BlueCross BlueShield Association (BCBSA)? - Answer-
national advertising, and owns and manages the BCBS trademarks and names
The difference between for-profit status and nonprofit status is that - Answer-for profit
corporations pay taxes on profits generated by the corporation.
When a policyholder moves into an area served by a different BCBS corporation than
the policyholder previously used, the plan must - Answer-allow conversion and
guarantee transfer of membership.
The preferred provider network (PPN) allowed rate is generally - Answer-10 percent
lower than the participating provider rate
Which is an incentive for a provider in sign a PPN contract? - Answer-written notification
of new employer groups and hospitals
An example of a benefit provided by BCBS basic coverage is - Answer-assistant
surgeon fees.
The BCBS plan type that offers choice and flexibility to subscribers is - Answer-
indemnity coverage.
A special accidental injury rider provides which benefit? - Answer-Nonsurgical care is
paid at 100 percent if treatment is received within the contract's established time frame.
What special handling is required for BCBS claims filed under the medical emergency
care rider? - Answer-ICD-10-CM codes must reflect a condition that requires immediate
care.
The conversion of CHAMPUS to TRICARE was the result of a(n) - Answer-successful
CHAMPUS Reform Initiative (CRI) demonstration project.
Lead agents of selected military treatment facilities (MTFs) hold what rank? - Answer-
commander
, The entire health care system of the U.S. uniformed services is known as the - Answer-
Military Health Services System (MHSS)
The organization responsible for the U.S. uniformed services is known as the - Answer-
TRICARE Management Activity.
The term sponsor
is used to describe - Answer-active duty, retired, or deceased military personnel.
Claims are submitted to the TRICARE - Answer-regional contractor
TRICARE plans are primary to - Answer-Medicaid
TRICARE nurse advisors are available 24/7 to assist with - Answer-treatment
alternatives and recommendations for care.
The entity responsible for the prevention, detection, investigation, and control of
TRICARE frauid, waste, and abuse is the - Answer-Program Integrity Office.
Which TRICARE option is a fee-for-service plan? - Answer-TRICARE standard
The Division of Coal Mine Workers' Compensation administers and processes claims
for the - Answer-Federal Black Lung Program.
Federal and state laws require employers to maintain workers' compensation coverage
to meet minimum standards, covering a majority of employees for work-related illnesses
and injuries - Answer-if the employee was not negligent in performing assigned duties.
The medical term for black lung disease is - Answer-pneumoconiosis
The Mine Safety and Health Administration (MSHA) is similar in purpose and intent to
the - Answer-Occupational Safety and Health Administration (OSHA).
Material Safety Data Sheets (MSDS) contain data regarding - Answer-chemical and
hazardous substances used at the worksite.
How long must records of employee vaccinations and accidental exposure incidents be
retained? - Answer-20 years
The Federal Employment Liability Act (FELA) and the Merchant Marine Act were
designed to - Answer-provide employees with protection from employer negligence.
Which agency is responsible for handling appeals for denied workers' compensation
claims? - Answer-State Workers' Compensation Commission
AND ANSWERS ALL CORRECT
Which is a function of the BlueCross BlueShield Association (BCBSA)? - Answer-
national advertising, and owns and manages the BCBS trademarks and names
The difference between for-profit status and nonprofit status is that - Answer-for profit
corporations pay taxes on profits generated by the corporation.
When a policyholder moves into an area served by a different BCBS corporation than
the policyholder previously used, the plan must - Answer-allow conversion and
guarantee transfer of membership.
The preferred provider network (PPN) allowed rate is generally - Answer-10 percent
lower than the participating provider rate
Which is an incentive for a provider in sign a PPN contract? - Answer-written notification
of new employer groups and hospitals
An example of a benefit provided by BCBS basic coverage is - Answer-assistant
surgeon fees.
The BCBS plan type that offers choice and flexibility to subscribers is - Answer-
indemnity coverage.
A special accidental injury rider provides which benefit? - Answer-Nonsurgical care is
paid at 100 percent if treatment is received within the contract's established time frame.
What special handling is required for BCBS claims filed under the medical emergency
care rider? - Answer-ICD-10-CM codes must reflect a condition that requires immediate
care.
The conversion of CHAMPUS to TRICARE was the result of a(n) - Answer-successful
CHAMPUS Reform Initiative (CRI) demonstration project.
Lead agents of selected military treatment facilities (MTFs) hold what rank? - Answer-
commander
, The entire health care system of the U.S. uniformed services is known as the - Answer-
Military Health Services System (MHSS)
The organization responsible for the U.S. uniformed services is known as the - Answer-
TRICARE Management Activity.
The term sponsor
is used to describe - Answer-active duty, retired, or deceased military personnel.
Claims are submitted to the TRICARE - Answer-regional contractor
TRICARE plans are primary to - Answer-Medicaid
TRICARE nurse advisors are available 24/7 to assist with - Answer-treatment
alternatives and recommendations for care.
The entity responsible for the prevention, detection, investigation, and control of
TRICARE frauid, waste, and abuse is the - Answer-Program Integrity Office.
Which TRICARE option is a fee-for-service plan? - Answer-TRICARE standard
The Division of Coal Mine Workers' Compensation administers and processes claims
for the - Answer-Federal Black Lung Program.
Federal and state laws require employers to maintain workers' compensation coverage
to meet minimum standards, covering a majority of employees for work-related illnesses
and injuries - Answer-if the employee was not negligent in performing assigned duties.
The medical term for black lung disease is - Answer-pneumoconiosis
The Mine Safety and Health Administration (MSHA) is similar in purpose and intent to
the - Answer-Occupational Safety and Health Administration (OSHA).
Material Safety Data Sheets (MSDS) contain data regarding - Answer-chemical and
hazardous substances used at the worksite.
How long must records of employee vaccinations and accidental exposure incidents be
retained? - Answer-20 years
The Federal Employment Liability Act (FELA) and the Merchant Marine Act were
designed to - Answer-provide employees with protection from employer negligence.
Which agency is responsible for handling appeals for denied workers' compensation
claims? - Answer-State Workers' Compensation Commission
