Practice Test for the PTCB Pharmacy Technician Certification Exam Correct 100%.

A Health Maintenance Organization (HMO) requires a patient to use ____ and either recommends or requires the use of ____. - ANSWER in-network pharmacies; generic drugs Patients in a Preferred Provider Organization (PPO) can use ____. - ANSWER in-network or out-of-network pharmacies The 4 parts of Medicare are: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage Plan that is private insurance), and Part D (______________________). - ANSWER prescription drug insurance What government entity runs Medicaid? - ANSWER state governments When a patient presents an insurance card, the information is entered into the computer, and a claim is sent to the insurance company for payment or rejection. The process of the insurance company accepting or rejecting a claim is called ____. - ANSWER adjudication The process in which a drug requires further review to determine if it is covered is called ____. - ANSWER prior authorization The codes used to bill different medical conditions are called ____. - ANSWER ICD codes Who is contracted by insurance companies to process the claims for the insurance company's members? - ANSWER PBM or Pharmacy Benefits Manager What is a flexible spending account? - ANSWER an account through a patient's employer where patients can use pre-tax dollars for medical expenses The term used to describe the services provided by a pharmacy to patients in an assisted living facility or a nursing home is called ____. - ANSWER long-term care Patients with more than one third-party payer will utilize this process for the benefits of both plans to be used. - ANSWER coordination of benefits / COB The block-rate payment collected from patients for their share of the prescription cost is called