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WTI Comp Ch. 13

Mosby's Chapter 13: Pharmacy Billing and Inventory Management

QuestionAnswer
When a workers’ compensation claim prescription is presented to the pharmacy, the technician should: Obtain information from the patient’s human resource department before filling.
The typical drugs included in a formulary are drugs that are: Generic
What are some government-managed programs? Medicare, Medicaid, TRICARE
What are valid reasons to return a medication to the warehouse or manufacturer for credit? Drug was recalled, Drug expired, Drug was damaged during delivery
Point-of-sale (POS) billing allows the insurance company to: Price a claim, Verify eligibility, Identify covered drugs
Workers’ compensation is paid for by: Employers
Some insurance policies require that the person pay a monthly: Premium
The amount to be charged to the insured patient for a prescription is decided by the ______________. Insurance company
What is one method of medication disposal that patients should be discouraged from using? Flushing the medication down the toilet
Which of the following is not a reason for the insurance company to reject a claim? Claim is a formulary medication.
Which of the following codes means that the physician has authorized a generic substitution? DAW 0
What illnesses are patients exempt from insurance company limitations? Diabetes, AIDS, HIV
Which of the following insurance plans requires a PCP? HMO
Supplemental insurance provided through private insurance companies that help cover costs not reimbursed by Medicare is called: Medigap plan
The processing of claims by insurance companies over a computerized system is called: Adjudication
What is true about PPOs? PPOs may have an annual deductible. PPOs do not require a PCP. The patient may have to pay full price for the prescription and then send in the receipt for later reimbursement.
The term third-party billing refers to the portion of payment: Reimbursed by insurance companies
The information needed by insurance companies to process a claim from the pharmacy or to reimburse the patient is the same as the information required on a pharmacy label, plus: Patient’s date of birth, Insurance group number, Insurance identification number
What is true of flexible spending accounts? The government limits the amount of money a person can put into these accounts each calendar year. Restrictions are placed on what services are covered. The plans are similar to a savings account.
Which part of Medicare helps pay for physicians’ services and outpatient care? Medicare Part B
What is meant by stock rotation? Bringing the items with the earliest expiration dates to the front so they are used first
A system that automatically tracks inventory is: Automatic dispensing systems (ADS)
What is a PAR level? Periodic automatic replenishment
In which circumstances do most insurance companies allow early refills? Extended vacation and Disaster situations
Which of the following types of medication require special ordering, inventory, storage, handling, and return documentation? Cytotoxic medications, Controlled substances, Investigational drugs
Both Medicare and Medicaid were implemented in: 1965
Medicare Part D specifically covers: Prescription medications
What types of patients are eligible for Medicare coverage? Disabled patients, Senior citizens, Dialysis patients
What is the meaning of AWP? Average wholesale price
PPO means: Preferred provider organization
The name a company assigns to a commercial drug product for marketing and identification purposes is called the _____________ name. Trade,Brand, orProprietary
An innovator product is a: Drug product that was first patented and marketed by the owner or manufacturer
What is meant by a back-ordered item? The ordered item is not currently in stock but will be sent as soon as it is available.
Created by: lrhamyWTI