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PTCB Study
Insruance Questions
| Question | Answer |
|---|---|
| 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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