PTCB EXAM 2023 CORRECT ANSWERS (Graded A+)

PTCB EXAM 2023 CORRECT ANSWERS (Graded A+) No NPI (National Provider Identifier) or invalid NPI on the claim. The pharmacist must have a contract with the payer. Once the contract is negotiated, the payer will provide an NPI number. This number is then inputted into the pharmacy software and included on all claims. 4-No Cardholder ID Number or invalid Cardholder ID number on the claim. To fix this, you must find the correct Cardholder ID number and resubmit the claim. 5- Plan Limitations Exceeded. If the claim submitted needs prior approval before coverage because of the medication expense, it may be rejected. Additionally, if the medication was already filled in the last 30 days or the quantity dispensed is over the allowed amount for the day supply, the claim may be rejected. To fix these issues, you will need to contact the insurance company to obtain an override or approval on the cost before resubmitting the claim. 6-Waiting Too Long to File the Claim. Most insurance companies allow 60 to 90 days from time of service to file a claim. When claims are filed past that time, the claim may be rejected. 7-Incorrect Patient Information. Any error in patient information will trigger a claim rejection. Common errors include incorrect name, days supply, provider, date of birth, etc. 8-Coverage has expired. If the patient does not pay premiums or no longer works at employer-provided insurance, the patient's coverage may not be current. 10-Coverage limits have been exceeded. The insurance plan may have a limit on the amount of coverage they provide for each patient annually or for a lifetime. The claim may be rejected if the coverage limits have been exceeded. 11-Refills. In some cases, the patient may be trying to get a prescription refilled when it either is not refillable or within too short of a time frame. The insurance payer may reject this claim. 12-Invalid Amount. The prescription may be written for an invalid amount of the medication. Most insurance companies cover only a 30-day supply of medication. Mail-order prescriptions may cover a 90-day supply. The amount depends on the actual drug. Coordination of Benefits (COB) - ANSWER is the process in which two or more health insurers cover the same person(s) but limit the total benefit payable for a claim to an amount not exceeding the total cost of the claim. Coordination of Benefits applies to retail pharmacy claims, member-submitted paper claims, and mail-order claims. Medicare, Medicaid, and private insurance companies have rules for determining who pays for the prescription in the case where more than one insurance payer covers the individual. The Birthday Rule for Dependents of Parents who Live Together: - ANSWER This rule determines whether a plan is primary or secondary for a dependent child who is covered by both parents.If both parents have the same birthday, then the plan that has been in effect the longest pays as primary. Birthday Rule for Dependents whose Parents are Divorced or Separated or are Not Living Together (Whether or Not They Have Ever Been Married: - ANSWER If the court decree states that one of the parents is responsible for the child's healthcare expenses/coverage and the plan covering that parent as actual knowledge of those terms, that plan is primary. If the responsible parent has no coverage for the child's healthcare expenses, but that parent's spouse does, that parent's spouse's plan is the primary plan. If a court decree states that both parents are responsible for the child's healthcare expenses/coverage, the Birthday Rule determines the order of benefits. If the court decree states that the parents have joint custody without specifying that one parent has healthcare coverage responsibility, the Birthday Rule determines the ordre of benefits. If there is no court decree allocating healthcare coverage responsibility for the child, the order of benefits for the child is as follows: a. the plan covering the custodial parent; b. the plan covering the custodial parent's spouse; c. the plan covering non-custodial parent; and then, d. the plan covering the noncustodial parent's spouse hood suould be operated ? - ANSWER 24 hours in hospitals pharmacy and at least 30 min prior to use in comunity pharmacy. what reasonable working distance from the Hood? - ANSWER work should be at least 6 inches into the hood. sterile instruments should be held under ? - ANSWER Class 100 (ISO 5) The federal food and drug act (1906) - ANSWER prohibited instersate commerce and adulterated and misbranded drugs. Fedral Food Drugs and Cosmetics Act ( FDCA1938) - ANSWER Established the FDA (stated the drugs cannot brought on the market untill proved to be safe), clarified the definition of misbranding and adulteration. Durham-Humphrey Amendment (1951) - ANSWER It requires the drug prove to be safe and print instructions clearly on the manufacture label. Created new legend drug what's known as prescription drug. And created warning (Caution Federal law prohibits dispensing without prescription) Currently the requirement has been changed in shorter warning (Rx only). The Kefauver-Harris Amendment (1962) - ANSWER This law requres for the first time a proof of the effectiveness of the drug as well as its safety. The food and administration modernization act (1997) - ANSWER This act simplifies many FSA regulations and procedures. It allows greater ease and speed with the FDA can approve a new drug and granted access to investigational medication. It's also abbreviated the warning to Rx Only