Review
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Is there a specific date range that states this is when you should enroll in medicare? If you are late in doing this you are called | Yes
Late Enrollee
🗑
|
||||
| For Medicaid, if you qualify for extra help with medical expenses do you have to re-apply every month? | No, it is granted yearly
🗑
|
||||
| Many states still require those receiving help through medicaid pay for some of their drug costs buy means of a ? | Copay
🗑
|
||||
| Part A | Inpatient hospital stays
🗑
|
||||
| Part A | Inpatient rehab facilities
🗑
|
||||
| Part A | Home health care
🗑
|
||||
| Hospice Care | Part A
🗑
|
||||
| Skilled nursing facility care (not long term) | Part A
🗑
|
||||
| Name the items on the medicare insurance card | Name, sex, Medical #, Part A and Part B and effective dates
🗑
|
||||
| Group of practicing doctors and other health care experts working to check and improve medicare are called? | Quality Improvement Organization
🗑
|
||||
| What part of medicare covers your bills if you are admitted into the hospital | Part A
🗑
|
||||
| Medicare Part C is also called | Medical Advantage Plan
🗑
|
||||
| This show all services and supplies billed to Medicare during a three month period | Medicare Summary Notice (MSN)
🗑
|
||||
| This is given to patient prior to treatment by a provider who thinks that a procedure will not be covered by Medicare because it will be deemed not reasonable and necessary | Advanced Beneficary Notice (ABN)
🗑
|
||||
| Groups of practicing doctors and other health care experts paid by the federal government to check and improve the care given to Medicare beneficiaries | Quality Improvement Organization QIO
🗑
|
||||
| This part covers prescription drugs | Part D
🗑
|
||||
| This part covers both preventive and regular services | Part B
🗑
|
||||
| Name the Five different kinds of medicare advantage plans | PPO, HMO, PFFS, MSA, SNP
🗑
|
||||
| Which tier would have a lower copay | Tier 1
🗑
|
||||
| What information is needed to enroll in medicare | Personal ID, permanent street address, Info on medical card
🗑
|
||||
| What is the minimum number of plans for different sponsors that must be available in each region of the country? | Two
🗑
|
||||
| Which part of medicare has private companies contracting with CMS to offer medicare through their own policies | Part C
🗑
|
||||
| CMS | Centers for Medicare and Medicaid Services
🗑
|
||||
| Which type of plan gives patients financial incentive to stay within the network but also allows them to go outside the network | PPO
🗑
|
||||
| A foot doctor | Podiatrist POD
🗑
|
||||
| Skin Doctor | Dermatologist
🗑
|
||||
| Eye Doctor | Ophthalmologist
🗑
|
||||
| The doctor who would replace a knee or hip | Orthopedic
🗑
|
||||
| The specialty of a primary care physician. He/she is also known as a | internal medicine
"Gate Keeper"
🗑
|
||||
| Gate Keeper | Who coordinates your health care
🗑
|
||||
| The BIN number - bank identification number - Identifies what ? | ID insurance plan. Where they route the money on the number ID's the insurance plan.
🗑
|
||||
| According to HIPAA - Documents / Medicare records that are generated and stored in the pharmacy belong to who | The Pharmacy that created them.
🗑
|
||||
| Who is required to follow HIPAA regulations? | Heath care clearing houses, health plans, and Health Care Providers.
🗑
|
||||
| The first comprehensive federal protection for the privacey of health information was the what? | HIPAA
🗑
|
||||
| What is considered PHI? | Birth date, License number, SSN, web site address, email and fingerprint
🗑
|
||||
| Under HIPAA health care providers are considered business associates? | No
🗑
|
||||
| Which of the following are considered PHI in regards to patient information | Written notes, oral communication and electronic transmission.
🗑
|
||||
| What % of people with private Health insurance have individual plan? | 10%
🗑
|
||||
| FEHB covers approximately now many people | 8 million. Federal Employees Health Benfits
🗑
|
||||
| What type of health insurance plan increases patient awareness of health care cost? | Consumer - Driven Health Plans
🗑
|
||||
| NDC# three sets of numbers represents | Labler, product, and Package size.
🗑
|
||||
| Professional fee for pharmacy prescription prosecessing | Dispensing Fee
🗑
|
||||
| The only pricing that is listed per unit | MAC
🗑
|
||||
| The agreement between a pharmacy and a pharmacy benefits manager | Participating Pharmacy Agreement
🗑
|
||||
| The formula for calculating inventory turnover rate | Cost of Goods sold/Average inventory on hand
🗑
|
||||
| Outdated Drugs | They are counted in inventory, Can sometimes be returned, should be pulled off the shelves
🗑
|
||||
| Who is the third party? | the Payer
🗑
|
||||
| When a patient with prescription insurance never comes to pick up the prescription that you filled for them? | Reverse transaction, reverse claim, and put back on shelve
🗑
|
||||
| What DAW code do you use when the patients insists on the brand name even though the Doctor said it was okay to substitute the generic | DAW - 2
🗑
|
||||
| What is the DAW Code - When the doctor indicated dispense as written instead of giving the generic | DAW - 1
🗑
|
||||
| What is the reason for an insurance company having a formulary | Control Cost
🗑
|
||||
| Missing invaild patient name might be due to this error | Wrong Birthdate
🗑
|
||||
| Prior authorization is required for | High cost meds, non formulary meds, and cosmetic meds.
🗑
|
||||
| High Dose alert | is Clinical
🗑
|
||||
| What type of health insurance plan pays specialists according to a contractual agreement? | HMO
🗑
|
||||
| Carge higher costs for out of network providers? | PPO and POS
🗑
|
||||
| What plan does not normally cover preventive care | Idemity Insurance
🗑
|
||||
| What plan will only pay if you stay within the network | HMO
🗑
|
||||
| When completing the patient information on a claim what information do you need | Cardholder ID, Group ID, Patient relationship
🗑
|
||||
| What information remains the same for each refill on a prescription | Patient ID number, Pharmacy ID number, and Name of the provider
🗑
|
||||
| When completing the prescriber information you need to record what | prescriber phone number, prescriber name and prescriber ID
🗑
|
||||
| When recording the patient information what do you need to include | Patient name, Patient's address, and Patient's gender.
🗑
|
||||
| Which is te first ste in completing claim | recording the patient information
🗑
|
||||
| If prior authorization is denied, what should the pharmacy technician do? | Tell the patient they can pay cash and Have the pharmacist contact the doctor for an alternative medication
🗑
|
||||
| Can a patient has about their insurance plan? | Yes
🗑
|
||||
| Pre-editing | Claims before submitting them to a PBM can identify data fields that are missing and invalid
🗑
|
||||
| PMPM | Per member per month
🗑
|
||||
| For prior authorization what information is needed | Pharmacist name, source of information(why they need it), diagnosis, and physician.
🗑
|
||||
| When recording the prescription information, you must include the following | Drug name, DEA number (if applicable), and drug dose.
🗑
|
||||
| A charge back | Insurance company makes error. Wants money back from pharmacy
🗑
|
||||
| Billing cycle includes which of the following steps | Patient interview, prescription receipt, and filling the prescription.
🗑
|
||||
| The final step in the billing cycle is? | Collections and problem resolution
🗑
|
||||
| What document is received by the pharmacy that show the detail for each claim? | Explanation of benefits and remittance advice.
🗑
|
||||
| This is the person who performs statistical analyses to determine what premiums need to be earned by the insurance company to cover expenses. | Actuary
🗑
|
||||
| Three of the four services within insurance pans that are often managed separately | Eye care, dental care, mental health care
🗑
|
||||
| Patient cost sharing comes in three forms. They are | Deductables, copays, coinsurance
🗑
|
||||
| Capitation payments and withholding funds are used in what type of managed care settings | HMO
🗑
|
||||
| PBM's control costs in 10 different ways. These include | Cost sharing and Therapeutic Interchange
🗑
|
||||
| DUR | Drug utilization Review
🗑
|
||||
| MAC | Max allowable Cost
🗑
|
||||
| The Pharmacy & Theraputic Committee | Develops the formularies for PBM's and hospitals.
🗑
|
||||
| DAW | Are nine codes that explain why a certain multiple source product was used or not used
🗑
|
||||
| CDHP | Consumer Driven Health Plan
🗑
|
||||
| Coordination of Benefits | A provision that ensures that when a patient is covered under more te benefits are paid, but without duplication
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Agoddess
Popular Miscellaneous sets