Pharm Tech Chapter 14 (financial Issues)

45 Questions

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Financial Accounting Quizzes & Trivia

- Financial issues, - Third Party Programs, - Online Adjudication, - Rejected Claims, - Other Billing Procedures


Questions and Answers
  • 1. 
    The resolution of prescription coverage through the communication of the pharamacy computer with the third party computer
    • A. 

      Online adjudication

    • B. 

      Medicaide

    • C. 

      Medicare

    • D. 

      Co-pay

  • 2. 
    The portion of the price of medication that the patient is requried to pay
    • A. 

      CMS-1500 form

    • B. 

      CMS - 10114 form

    • C. 

      Co-insurance

    • D. 

      Co-pay

  • 3. 
    The maximum price per tablet (or tother dispensing unit) an insurer or PBM will pay for a given product
    • A. 

      HMO's

    • B. 

      Maximum allowable cost (MAC)

    • C. 

      Dual co-pay

    • D. 

      Co-insurance

  • 4. 
    A federal-state program, administered by the states, providing health care for the needy
    • A. 

      Medicaid

    • B. 

      Medicare

    • C. 

      Midication therapy management services (MTMS)

    • D. 

      None of the above

  • 5. 
    A cost-sharing agreement bettween the insurer and the insured
    • A. 

      Co-insurance

    • B. 

      Co-pay

    • C. 

      Deductible

    • D. 

      Dual co-pay

  • 6. 
    Co-pays that have two prices: one for generic and one for brand medications
    • A. 

      Formulary

    • B. 

      Dual co-pay

    • C. 

      Co-pay

    • D. 

      Co-insurance

  • 7. 
    A set amount that must be paid by the patient for each benefit period before the insurer will cover additional expenses
    • A. 

      Current procedural terminology codes (CPT CODES)

    • B. 

      Dual co-pay

    • C. 

      Deductible

    • D. 

      Medicare

  • 8. 
    A network of providers for which costs are covered inside but not outside of the network
    • A. 

      HMO's

    • B. 

      Medication Therapy Management Services ( MTMS )

    • C. 

      National Provider Identifier (NPI)

    • D. 

      Fromulary

  • 9. 
    A federal program providing health care to people with certain disabilities over age 65
    • A. 

      Cms-1500 form

    • B. 

      Cms-10114 form

    • C. 

      Co-insurance

    • D. 

      Co-pay

  • 10. 
    Service provided to some Medicare beneficiaries who are enrolled in Mediare Part D and who are taking multiple medicatons or have certain diseases
    • A. 

      Medication Therapy Management Services (MTMS)

    • B. 

      National Provider Identifier (NPI)

    • C. 

      Online adjudication

    • D. 

      Deductible

  • 11. 
    The code assigned  recognized health care providers; needed to bill MTMS
    • A. 

      Online adjuication

    • B. 

      Medicare

    • C. 

      Medicaid

    • D. 

      None of the above

  • 12. 
    The standard from used by health care proviers to apply for a National Provider Identifier (NPO)
    • A. 

      Cms-1500 form

    • B. 

      Cms-10114 form

    • C. 

      Co-pay

    • D. 

      Co-insurance

  • 13. 
    A list of medications that are covered by a third party plan
    • A. 

      Open formulary

    • B. 

      Closed formulary

    • C. 

      Formulary

    • D. 

      None of the above

  • 14. 
    Companies that administer drug benefit programs
    • A. 

      Pharmacy benefit managers

    • B. 

      POSs

    • C. 

      Prescription Drug Plans PDPs

    • D. 

      Universal claim form

  • 15. 
    A standard paper claim from accepted by many insurers
    • A. 

      PPOs

    • B. 

      POSs

    • C. 

      U&C or UCR

    • D. 

      Tier

  • 16. 
    The maximum amount of payment for a given prescription, determined by the insurer to be usual and customary (and reasonable) price
    • A. 

      U&C or UCR

    • B. 

      POSs

    • C. 

      PPOs

    • D. 

      Tier

  • 17. 
    Manufacturer sponsored prescription drug programs for the needy
    • A. 

      Pharmacy benefit mangers

    • B. 

      Prescription drug benefit cards

    • C. 

      Patient assistance programs

    • D. 

      Universal claim from

  • 18. 
    Cards that contain third party billing information for prescription drug purchases
    • A. 

      Prescription drug plans (pdps)

    • B. 

      Prescription drug benefit cards

    • C. 

      Universal claim form

    • D. 

      Worker's compensation

  • 19. 
    A network of providers where costs outside the network may be partially reimbursed and the patient's primary care physician need not be a member
    • A. 

      POSs

    • B. 

      Ppos

    • C. 

      Pdps

    • D. 

      None of the above

  • 20. 
    An employer compensation program for employees accidentally injured on the job
    • A. 

      Worker's compensation

    • B. 

      UNIVERSAL CLAIM FORM

    • C. 

      TIER

    • D. 

      All the above

  • 21. 
    Third party programs for Medicare Part D.
    • A. 

      Prescription drug benefit cards

    • B. 

      Prescription drug plans pdps

    • C. 

      Ppos

    • D. 

      Pos

  • 22. 
    Categories of medications that are covered by a third party plan
    • A. 

      Tier

    • B. 

      Pos

    • C. 

      Pdps

    • D. 

      Ppo

  • 23. 
    Companies that administer drug benefit programs are called
    • A. 

      Pharmacy benefit managers

    • B. 

      MACs

    • C. 

      HMOs

    • D. 

      Employers

  • 24. 
    Another party, besides the patient or the pharmacy, that pays some or all of the cost of the medication is a(an)
    • A. 

      Third party

    • B. 

      Co-insurance

    • C. 

      MAC

    • D. 

      UCR

  • 25. 
    AN AGREEMENT FOR COST-SHARING BETWEEN THE INSURER AND THE INSURED IS CALLEDD
    • A. 

      MAC

    • B. 

      Dual co-pay

    • C. 

      Co-insurance

    • D. 

      Co-pay

  • 26. 
    The portion of the price of the medication that the paitent is required to pay is called the?
    • A. 

      Co-insurance

    • B. 

      Co-pay

    • C. 

      Maximum allowable cost

    • D. 

      Usual and customary price

  • 27. 
    Pharmacies receive payment from theird parities equal to
    • A. 

      The retail price of the drug

    • B. 

      The manufacturer's cost

    • C. 

      A wholesaler's price

    • D. 

      None of the above

  • 28. 
    Plans in which the patien pays a different amount depending on whether a generic or brand name medication is dispensed have
    • A. 

      Dual co-pays

    • B. 

      MAC

    • C. 

      Duplicate pricing

    • D. 

      UCR

  • 29. 
    IF A THIRD PARY PALN HAS A DUAL CO-PAY, THE PATIENT USUALLY PAYS ____ FOR GENERIC DRUGS COMPARED TO BRAND NAME DRUGS
    • A. 

      The same amount

    • B. 

      Less

    • C. 

      More

    • D. 

      None of the above

  • 30. 
    HMOs, POS, and PPOs are examples of
    • A. 

      Co-insurance

    • B. 

      Managed care programs

    • C. 

      MAC

    • D. 

      Co-pays

  • 31. 
    A(an) ______ is a network of providers for which costs are covered inside, but not outside of the network
    • A. 

      POS

    • B. 

      HMO

    • C. 

      MAC

    • D. 

      PPO

  • 32. 
    A(an) _____ is a network of providers where costs outside the network may be partially reimbursed and the patient's primary care physician need not be a member.
    • A. 

      Medicare

    • B. 

      Ppo

    • C. 

      Medicaid

    • D. 

      Hmo

  • 33. 
    Which type of managed care program is least likely to require substitution?
    • A. 

      Medicare

    • B. 

      Ppo

    • C. 

      Medicaid

    • D. 

      Hmo

  • 34. 
    A drug formulary is
    • A. 

      A list of medications that are covered by a third party program

    • B. 

      An official compendium of the FDA

    • C. 

      A listing of the ingredients in a prescription

    • D. 

      The price of a prescription under third party program

  • 35. 
    _____ is a federal-state program, administered by states, providing health care for the needy
    • A. 

      Medicaid

    • B. 

      Hmo

    • C. 

      Medicare

    • D. 

      Ppo

  • 36. 
    Closed formulary programs, such as medicaid, may cover drugs that are not on the formulary through a process called
    • A. 

      Dual co-pay

    • B. 

      Co-insurance

    • C. 

      Pos

    • D. 

      Prior authorization

  • 37. 
    PATIENT ASSISTANCE PROGRAMS ARE OFFERED BY
    • A. 

      Hmo

    • B. 

      Pharmacies

    • C. 

      Physicians

    • D. 

      Pharmaceutical manufacturers

  • 38. 
    Which of the following information is generally not required in online claim processing
    • A. 

      Birth date

    • B. 

      Weight

    • C. 

      Sex

    • D. 

      Group number

  • 39. 
    The DAW indicator that is appropriate for online adjudication if a physician has hand written DAW  on the prescription
    • A. 

      4

    • B. 

      2

    • C. 

      1

    • D. 

      3

  • 40. 
    When there is a question on insurance coverage for an online claim, the pharmacy technician can
    • A. 

      Telephone the insurance plan's pharmacy help desk

    • B. 

      Immediately refer the problem to the pharmacist

    • C. 

      All the above

    • D. 

      None of the above

  • 41. 
    When a technician receives a rejected claim "NDC Not covered", this probably means?
    • A. 

      The insurance plan has a closed formulary

    • B. 

      The insurance plan has an open formulary

    • C. 

      The birth date submitted does not match the birth date in the insurer's computer

    • D. 

      The patient has mail order

  • 42. 
    When a technician receives a rejected claim "invalid person code, " this probably means
    • A. 

      The patient is on medicare

    • B. 

      The patient has a mail order program

    • C. 

      The person code entered does not match the birth date and/or sex in the insurer's computer

    • D. 

      The patient is on medicaid

  • 43. 
    When a techician receives a rejected claim "unable to Connect, " this probably means
    • A. 

      The insurer has an incorrect birth date for the patient

    • B. 

      The patient's coverage has expired

    • C. 

      The connection with the insurer's computer is temporarily unavailable due to computer problems

    • D. 

      The insurer has a closed formulary

  • 44. 
    A standard form used by healthcare providers to bill for services is
    • A. 

      A universal claim form (UCF)

    • B. 

      A pdf

    • C. 

      An NDC

    • D. 

      Cms-1500

  • 45. 
    The CPT Codes for billing Medication Therapy Management Services provided by pharmacists are
    • A. 

      ICD-9

    • B. 

      MAC

    • C. 

      PPO

    • D. 

      99605,99606, and 99607