PTCB - Pharmacy Billing And
Reimbursement QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
100% CORRECT!!!
medicare advantage (medicare part C) - ANSWER✔✔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.
medicare part A - ANSWER✔✔a federally funded health care program that pays
for a patient's inpatient hospital care, skilled nursing care, hospice care, and home
health care
medicare part B - ANSWER✔✔a federally funded health care program that
provides a patient with coverage for physician visits, outpatient care, physical
therapy, and occupational therapy.
medicare part D - ANSWER✔✔a federally funded health care program that
provides a patient with coverage for select prescription medications, medical
supplies, insulin, and vaccinations.
Medicaid - ANSWER✔✔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
average wholesale price - ANSWER✔✔the average price that wholesalers sell a
medication
, actual acquisition cost - ANSWER✔✔actual cost a pharmacy paid for a
medication
formulary - ANSWER✔✔a list of medications approved for use or reimbursement
under a prescription plan.
open formulary - ANSWER✔✔a variety of several medications in each therapeutic
classification
closed formulary - ANSWER✔✔a very limited number of medications available in
each therapeutic classification, and sometimes no medications in certain
classifications.
restricted formulary - ANSWER✔✔a selective, limited, partially closed formulary
in which some non-formulary medications are available.
online adjudication - ANSWER✔✔the process by which a pharmacy submits
prescription claims electronically to a third party provider when filling a
prescription to ensure accurate copayments and timely payment. it allows the
pharmacy to verify a patient's eligibility and to determine the plan name, patient
identification, and group number from Medicare.
National Provider Identifier - ANSWER✔✔a unique number assigned to health
care provider, to transmit health information according to the HIPAA
identification number - ANSWER✔✔given to a patient so that their insurance
coverage can be authorized by a pharmacy
Reimbursement QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
100% CORRECT!!!
medicare advantage (medicare part C) - ANSWER✔✔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.
medicare part A - ANSWER✔✔a federally funded health care program that pays
for a patient's inpatient hospital care, skilled nursing care, hospice care, and home
health care
medicare part B - ANSWER✔✔a federally funded health care program that
provides a patient with coverage for physician visits, outpatient care, physical
therapy, and occupational therapy.
medicare part D - ANSWER✔✔a federally funded health care program that
provides a patient with coverage for select prescription medications, medical
supplies, insulin, and vaccinations.
Medicaid - ANSWER✔✔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
average wholesale price - ANSWER✔✔the average price that wholesalers sell a
medication
, actual acquisition cost - ANSWER✔✔actual cost a pharmacy paid for a
medication
formulary - ANSWER✔✔a list of medications approved for use or reimbursement
under a prescription plan.
open formulary - ANSWER✔✔a variety of several medications in each therapeutic
classification
closed formulary - ANSWER✔✔a very limited number of medications available in
each therapeutic classification, and sometimes no medications in certain
classifications.
restricted formulary - ANSWER✔✔a selective, limited, partially closed formulary
in which some non-formulary medications are available.
online adjudication - ANSWER✔✔the process by which a pharmacy submits
prescription claims electronically to a third party provider when filling a
prescription to ensure accurate copayments and timely payment. it allows the
pharmacy to verify a patient's eligibility and to determine the plan name, patient
identification, and group number from Medicare.
National Provider Identifier - ANSWER✔✔a unique number assigned to health
care provider, to transmit health information according to the HIPAA
identification number - ANSWER✔✔given to a patient so that their insurance
coverage can be authorized by a pharmacy
