Pharm Tech Chapter 14 (Financial Issues)
- Financial issues, - Third Party Programs, - Online Adjudication, - Rejected Claims, - Other Billing Procedures
- 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
Questions: 10 | Attempts: 11709 | Last updated: Jun 16, 2022
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