PTCB Pharmacy Billing and Reimbursement Exam Questions and Answers (2024 / 2025) (Verified Answers)

1. medicare advantage (medicare part C): allows participants in Medicare Part A and B to obtain coverage through a Health Maintenance Organization or Preferred Provider Organization that provides additional services at a higher cost. 2. medicare part A: a federally funded health care program that pays for a patient's inpatient hospital care, skilled nursing care, hospice care, and home health care 3. medicare part B: a federally funded health care program that provides a patient with coverage for physician visits, outpatient care, physical therapy, and occupational therapy. 4. medicare part D: a federally funded health care program that provides a patient with coverage for select prescription medications, medical supplies, insulin, and vaccinations. 5. Medicaid: a federal program based on income as well as other circumstances. eligibility is determined on a month by month basis. it generally covers doctors visits, emergency care, hospital care, vaccinations, prescriptions, vision, hearing, and preventative care for children 6. average wholesale price: the average price that wholesalers sell a medication 7. actual acquisition cost: actual cost a pharmacy paid for a medication 8. formulary: a list of medications approved for use or reimbursement under a prescription plan. 9. open formulary: a variety of several medications in each therapeutic classifica- tion