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Ch.1 Insurance

Becoming a Pharm Tech Insurance Specialist

QuestionAnswer
In an average year, Americans spend this much on outpatient prescription medications. This amount is growing and is expected to continue to increase. Around $180 billion
Some contracts do not demand a deductible, and provide this. It begins with the first charge of the year. First-dollar-coverage
Insurance term referring to appropriate medical treatment given under generally accepted standards of medical practices Medically necessary
Medically necessary procedures are approved by this An appropriate federal regulatory agency, such as the FDA
Policies that have this usually provide coverage for a selection of prescription medications Pharmacy benefit
A fee paid monthly to a health plan by a person who buys medical insurance Premium
List containing the FDA-approved brand-name and generic medications a plan covers Formulary
Method of supervising medical care with the goal of ensuring that patients get needed services in the most appropriate, cost-effective setting Managed care
Workers' Compensation benefits vary according to this State law
Low-income people who can't afford health insurance can be covered by this Medicaid
Federal health plan that covers most citizens aged 65 or over Medicare
Program for veterans with permanent service-related disabilities CHAMPVA
Errors in the claim process can result in this. Slowed or denied payments
The process of checking to verify that each claim reimbursed by a payer is correct according to the expected payment Reconciliation
This is as important as knowing about specific forms, codes, and regulations Communication skills
Give examples of preventive medical services Prenatal care, annual physical exams, pediatric and adolescent immunizations, and routine cancer screening procedures such as mammograms
Document that comes to a pharmacy showing the details for a claim. Also known as an explanation of benefits. Remittance advice
The final step in the pharmacy billing cycle Collections and problem resolution
Describe Step 6 of the pharmacy billing process: Point-of-Sale Payment Give the patient the prescription and collect payment. Pharmacist consults with patient.
This step of the pharmacy billing process involves internal processing of the claim for payment to the pharmacy Step 7: Calculation of Payer Claim Balance
Payments made by a health plan for medical services Benefits
A medical condition a policyholder was diagnosed with before a policy was written Preexisting condition
Monetary amount after which a plan's benefits end, also known as a maximum benefit limit Lifetime limit
Copayments are always paid at this time At the time of service
Payer's processing of claim data to decide whether a drug is covered by the patient's plan and is properly utilized Adjudication
An insurance policy that contains a list of covered medical services Schedule of benefits
Percentage of the fees owed by the policyholder coinsurance
The use of software to transmit a prescription order Electronic prescribing
Created by: sarakiefer
 

 



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