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pharm tech ch 14
quiz
| Question | Answer |
|---|---|
| The number used to identify the drug when billing a PMB for a filled prescription | (NDC) National Drug Code |
| Process for using a computer to determine the exact coverage for a prescription with the appropriate third party | Online Adjudiction |
| The type of managed care program that is most restricted | HMO |
| Component of Medicare that covers MTMs | Part D |
| Another party besides the patient of the pharmacy that pays for some or all of the cost of a medication | Third Party Program (insurer) |
| Employer compensation program for employees accidentally injured on the job | Workers' Compensation |
| Component of medicare that covers inpatient hospital expenses | Medicare Part A |
| Which form is used by health care providers to apply for a National Provider Identifier? | CMS-10114 form |
| The number used to identify the provider of MTMs when billing for services under Medicare Part D | (NPI) National Provider Identifier |
| Which CPT (Current Procedural Terminology) code is for a first-encounter with a patient and may be billed in 1-15 increments | 99605 |
| Component of medicare that covers prescription drugs | Medicare Part D |
| Medicare and Medicaid are examples of | Public Health Insurance |
| Component of medicare that covers doctors services and other medical services that are not covered under Medicare Part A | Medicare Part B |
| A set amount that must be paid by the patient for each benefit period before the insurer will cover additional costs | Deductible |
| A company that administers drug benefit programs for insurance companies or employers | (PBM's) Pharmacy benefit manager |
| DAW 1 means: | handwritten on the prescription by the prescriber |
| An agreement for cost sharing between the insurer and insured | Co-insurance |
| Federal health insurance program for people over age of 65 or people with kidney failure | Medicare |
| A rejected claim for invalid person code following online adjudication of a prescription claim | When the birthdate is submitted to the pharmacy doesn't match the birthdate in the insurer's computer |
| A form for billing pharmaceutical care services | CMS 1500 |
| The maximum amount of cost that will be covered for a perscription as determined by the insurance plan | (MAC) Maximum Allowable Cost |
| Programs sponsored by the pharmaceutical manufacturers to help provide medications for the needy | Patient Assistant Programs |
| A federal-state program that covers health expenses | Medicaid |
| A form for billing Medication Therapy Management Services | CMS 1500 |
| A protion of the price of medication that a patient is required to pay | Co-pay |
| What form is used for prior authorization only for patients on California Medi-Cal | TAR |
| DAW 2 means: | Patient requested brand |
| If a drug is not covered on the patient's formulary you would recieve rejection: | NDC not covered |
| Component of Medicare that covers doctors' services, DME, and other medical services that are not covered under Medicar Part A | Part B |
| A standard claim form accepted by many insurers | Universal Claim Form (UFC) |
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QUICEL001
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