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Pharmacy Billing and Reimbursement PTCB Practice Test Questions and Answers Latest Rated A+
Question 1: Medicare Advantage (Medicare Part C)
CORRECT 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.
Question 2: Medicare Part A
CORRECT 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
Question 3: Medicare Part B
CORRECT ANSWER : a federally funded health care program
that provides a patient with coverage for physician visits, outpatient care, physical therapy, and occupational therapy.
Question 4: Medicare Part D
CORRECT ANSWER : a federally funded health care program
that provides a patient with coverage for select prescription medications, medical supplies, insulin, and vaccinations.
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Question 5: Medicaid
CORRECT 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
Question 6: Average wholesale price
CORRECT ANSWER : the average price that wholesalers sell a
medication
Question 7: Actual acquisition cost
CORRECT ANSWER : actual cost a pharmacy paid for a
medication
Question 8: Formulary
CORRECT ANSWER : a list of medications approved for use or
reimbursement under a prescription plan.
Question 9: Open formulary
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CORRECT ANSWER : a variety of several medications in each
therapeutic classification
Question 10: Closed formulary
CORRECT ANSWER : a very limited number of medications
available in each therapeutic classification, and sometimes no medications in certain classifications.
Question 11: Restricted formulary
CORRECT ANSWER : a selective, limited, partially closed
formulary in which some non-formulary medications are available.
Question 12: Online adjudication
CORRECT 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.
Question 13: National Provider Identifier
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CORRECT ANSWER : a unique number assigned to health care
provider, to transmit health information according to the HIPAA
Question 14: Identification number
CORRECT ANSWER : given to a patient so that their insurance
coverage can be authorized by a pharmacy
Question 15: Insurance premium
CORRECT ANSWER : when an insurance company charges an
individual to maintain their insurance coverage
Question 16: Health Maintenance Organizations
CORRECT ANSWER : focus on keeping their patients healthy
by providing small co-pays and minimal to no deductibles.
Question 17: Preferred Provider Organizations
CORRECT ANSWER : offer health care services for a
discounted fee by using non-exclusive contracts with network providers.
