Chapter 14:
- Chapter 14 defines the eligibility for TRICARE participants and identifies the different types of benefits available to veterans and their families. Also discussed are CHAMPUS and CHAMPVA. Submitting claims to TRICARE using the CMS-1500 and the UB-04 is also covered.
Chapter 17:
- The Occupational Safety and Health Act (OSHA) was signed into law on December 29, 1970, and created the Occupational Safety and Health Administration. Prior to this act, employees injured or killed on the job had to take legal action against the employer to receive compensation. Distinction is made between federal workers’ compensation and state worker’s compensation claims. Different classifications of work-related injuries are explained, along with the injured worker’s rights and responsibilities. The medical office specialist must understand that the role of an ombudsman is assisting with claims, the four types of workers’ compensation benefits, and the different types of disability. Completion of a CMS-1500 form for workers’ compensation is explained, as well as the determination of the workers’ compensation fees based on the Medicare Fee Schedule (MFS).
Key Terms
beneficiary
Civilian Health and Medical program of the Uniformed services(CHAMPUS)
Civilian Health and Medical Program of the Department of Veterans Affairs(CHMPVA)
Defense Enrollment Eligibility Reporting System (DEERS)
Catastrophic cap
Cost share
TRICARE Senior Prime
TRICARE Standard
TRICARE prime
Sponsor
TRICARE Young Adult (TYA)
TRICARE Reserve Select (TRS)
TRICARE
Primary care manager (PCM)
TRICARE Reserve Retried (TRR)
TRICARE Prime Remote(TPR)
TRICARE for Life (TFL)
Nonavailability statement (NAS)
Palmetto Government Benefits Administrator(PGBA)
Wisconsin physicians Services(WPS)
TRICARE Extra
Military treatment facility(MTF)
Independent review organization (IRO)
Admission of liability
Burial benefits
Death benefits
lifetime income benefits
maximum medical improvement (MMI)
Disability compensation programs
District of Columbia Workers’ Compensation Act
Employer’s First Report of Injury or Illness
Energy Employees Occupational Illness Compensation Program Act (EEOICP)
Federal Coal Mine Health and Safety Act (Black Ling Benefits Reform Act)
Federal Employees’ Compensation Act (FECA)
Final report
Fraud indicators
Impairment
Impairment income benefits
Impairment rating
Income benefits
Longshore and Harbor Workers’ Compensation Act (LHWCA)
Office of Workers’ Compensation Program (OWCP)
Ombudsmen
Physician of record
Social Security Disability Insurance (SSDI)
medical benefits
Notice of Contest
Treating doctor
Veteran’s Disability Compensation
Veteran’s Disability Pension Benefits
Vocational rehabilitation
Work Status Report
occupational diseases and illnesses
Occupational Safety and Health Act
Occupational Safety and Health Administration (OSHA)