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 |