Pharmacy Billing and Reimbursement PTCB Practice Test Questions and Answers Latest Rated A+

Pharmacy Billing and Reimbursement PTCB Practice Test Questions and Answers Latest Rated A+. Which government insurance plans offers 4 different parts or areas of different coverage? A. MedicareB. Medicaid C. TRICARE D. CHAMPVA 2. DAW/DNS stand for which of the following? A. Dispense as written B. Distribute and work C. Distribution and working D. Dispense as well 3. Which of the following third party plans requires the patient to designate a primary care physician (PCP)? A. Health maintenance organization (HMO) B. Preferred provider organization (PPO) C. Medicare Part D D. TRICARE 4. The cost of the coverage of an insurance policy is known as which of the following? A. Deductible B. Co-payment C. Coinsurance D. Premium 5. Which of the following is another name for the cardholder of the insurance policy? A. Subscriber B. Dependent Pharmacy Billing and Reimbursement PTCB Practice Test Questions and Answers Latest Rated A+ C. Patient D. Third party 6. When a patient picks up a prescription in the pharmacy, he or she may be responsible for an out-of-pocket expense known as which of the following? A. Co-payment B. Premium C. Deductible D. Third party 7. The part of Medicare that covers the costs of prescriptions for Medicare patients is known as which of the following? A. Part A-COVERS IN-PATIENT , HOSPITALIZATION, B. Part B—COVERS OUT-PATIENT,MEDICAL SUPPLIES, PREVENTATIVE SERVICES C. Part C-SUPPLEMENTAL INSURANCE-COMBINED D. Part D-COVERS PRESCRIPTION, DIABETES SUPPLIES 8. Which organization oversees Medicaid and Medicare? A. Food and Drug Administration (FDA) B. Drug Enforcement Agency (DEA) C. Centers for Medicare and Medicaid Services (CMS) D. United States Pharmacopeia (USP) 9. Which of the following is a formulary? A. A list of insurance companies that offer pharmacy benefits B. List of providers that are included in an HMO C. List of approved medications in a member’s plan D. Recipe for how to make specific medications 10. If a drug is not covered under a patient’s prescription plan, but the prescriber specifically wants the patient to have this medication, the insurance company may require which of the following? A. Formulary B. Prior authorization C. Adjudication- ELECTRONIC SUBMISSION OF CLAIMS D. Coordination of benefits11. Which code is used for the third party to determine if the proper brand or generic medication was used to fill the prescription? A. USAN B. DAW C. Adjudication D. Trade 12. Which of the following DAW code is submitted when a generic drug is dispensed or a brand name product that does not have a generic available? A. DAW 0- NO PRODUCT SELECTION INDICATED B. DAW 1- DISPENSE AS WRITTEN C. DAW 2-PT REQUEST PRODUCT TO BE DISPENSE D. DAW 3-SUBSTITUTION ALLOWED PHARMACY REQUESTED E. DAW 4- SUBSTITUTION ALLOWED GENERIC NOT IN STOCK F. DAW 5- SUBSTITUTION ALLOWED BRAND DRUG DISPENSE AS GENERIC G. DAW 6- OVERRIDE H. DAW 7- SUBSTITUTION NOT ALLOWED BRAND DRUG MANDATED BY LAW I. DAW 8- SUBSTITUTION NOT ALLOWED GENERIC NOT AVAILABLE IN THE MARKET PLACE- BACK-ORDER J. DAW 9- OTHERS 13. After a claim has been submitted, what is the process of evaluating a medication for specific drug safety and cost-effectiveness measures known as? A. Coordination of benefits B. Drug utilization review C. Prior authorization D. Coinsurance 14. The deductible is the amount that must be paid when? A. Each time when prescription is picked up B. Each year before the policy kicks in C. Monthly to cover the insurance plan D. As a percentage of the cost of services 15. If a patient has coinsurance that pays 90% of services, and their prescription cost $50, how much will they owe the pharmacy? A. $5 B. $10 C. $15 D. $25 16. Which of the following is an example of a third party plan? A. HOM B. Prior authorization C. Adjudication D. Premium 17. Which of the following is an example of a private insurance company? A. Medicare B. Medicaid C. TRICARE D. Aetna 18. A patient pays a $500 deductible and a total of $100 in co-pays for the year. The total $600 is called which of the following? A. Premium B. Out-of-pocket expenses C. Coinsurance D. Point-of-service 19. CMS represents which organizations? A. TRICARE and Medicare B. Medicare and Medicaid C. TRICARE and CHAMPVA