Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
pht 100
chapter 7 part 4
| Question | Answer |
|---|---|
| health insurance can cover | visits, lab costs, & hospitalization |
| many small employers don't have | insurance for employees |
| cost of private health insurance is | often prohibitive |
| medical & medicare offer | eligible applicants coverage |
| many insurance companies process claims by | rx benefits managers |
| prescription benefits manager is | PBM |
| techs should know that a deductable is the | insurance paid amount |
| co-payments are the | customer paid amounts |
| tiered co-pay is an escalating cost/co-pay for | generic rx's & (non)prefered brands |
| online adjudication uses electronic communcation to | process rx claims |
| when billing to a PBM, the pharm] right away finds out | what to charge the patient, how much reimbursement for the pharm] is whether or not the cost is covered, or if deductible is met first |
| online adjudication is real time insurance claims processed by | wireless telecommunications |
| medicaid is operated by each state & subsidizes | healthcare for indigent & disabled citizens |
| state reimbursement to pharm]s is limited to | "usual & customary charges" |
| some communicate pharm]s don't process | medicaid coverage due to low reimbursement rates or other factors |
| medicaid is state gov'tal & is for | low-income & disabled citizens |
| tricare is a federal plan with health/drug coverage for | active/retired military members & their families |
| tricare has low co-pays & covers | 90 days worth of medical supplies |
| medicaid part d is voluntary; | patients may continue current drug coverage |
| medicaid pt. d is complex; there are many coverage choices but patients usually | save 25-30% on rx's |
| medicaid pt. d has a coverage gap or "donut hole" when | yearly drug costs are between $3000-5500 |
| within the medicaid pt. d gap, patients must | pay 100% of costs |
| medicaid pt. d has a list of | lower cost preferred drugs |
| techs can help patients understand their | insurance coverage |
| workers comp. is temporary insurance & the drug coverage is limited to | needs for injury treatment |
| workers comp. is a | secondary insurer |
| techs sometimes must coordinate benefits between | customers primary & secondary insurance |
| pharm] software determine | resolution methods |
| techs should learn about insurance plans & their interface with | the pharm] software |
| a coordination of benefits is an online billing of | primary/secondary insurers |
| getting & entering insurance info is | challenging |
| any change in insurance must be | updated when entered |
| insurance info includes | patient id & code, rx plan provider, BIN no., processor control no., & group id |
| insurance claims may be denied if | day supply is miscalculated |
| pharm]s may directly bill | insurance plan |
| discount cards & coupons may | be used also |
| PA is when the prescriber or tech calls the | insurance company for drug coverage to justify use |
Created by:
wildap
Popular Chemistry sets