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PTCB Study

Insruance Questions

Polices that have a pharmacy benefit do not provide coverage for a selection of prescription medications T or F True
If a policyholder or a covered dependent gets sick, the health plan pays most of the bill. True or False True
Workers compensation cases vary according to? State Law
A remittance advice is also known as an explanation of benefits
The final step in the pharmacy billing cycle is Collections and problem resolution
The balance due on a claim is likely to be paid about how many days after the day of service? 30-60 days
An electronic data interchange may be sent during which step of the pharmacy billing cycle? Pharmacy Claim Transmital
The payer starts internal processing of the claim for payment to the pharmacy during which step of the pharmacy billing cycle? Calculation of payer claim balance
States may not restrict price increases on premiums and other charges to patients True or False False
Pharmacies cannot withhold the information in a patient's medical records unless provding it would be detrimental to the patient's health True or false True
Which of the following is not one of the ways CMS preforms activities to ensure the quality of health care? Setting prices for prescription drugs and physician visit
CMS administers the Medicare and Medicaid programs to more than 90 Million americans
To further regulate the health care industry, states may do all of the following except Create their own guidelines to replace federal guidelines
Pharmacy benefit managers are hired by employers to operate their prescription drug benefit more inexpensively T OR F True
Patients who belong to a preferred provider organization are required to see providers within the network T OR F Falce
What can employees purchase to add coverage such as vision and dental services? Riders & Options
A third-party administrator of prescription drug programs that processes and pay prescription drug claims is called a Pharmacy benefit manager
The federal government pays Medicare claims directly. T OR F False
Everyone who is enrolled in Medicare Part A is automatically enrolled in Medicare Part B. T OR F False
Medicare Part B dose not cover emergency services T OR F False
What is the maximum amount a NonPAR provider could charge a Medicare procedure listed at $200 in the Medicare nonparticipating fee schedule? $230
Medicare has two major parts, one for care given by institutions and the other for services by Physicians
To pay medicare claims, the federal government contracts with insurance organizations known as Medicare administrative contractors
People who are eligible for Social Security benefits are automatically enrolled in Medicare part A
Created by: IceQueen1981



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