Deck 1: Insurance

Question 1

How old does a patient without a disability or kidney disease have to be in order to qualify for Medicare?

A)65 years old
B)70 years old
C)60 years old
D)75 years old

Answer 1

65 years old

Question 2

Which of the following patients would qualify for Medicare?

A)A 68 year old healthy patient
B)A 35 year old patient with chronic kidney disease
C)A 25 year old disabled patient
D)All of the above

Answer 2

All of the above

Question 3

A patient comes to your pharmacy with medication for pain resulting from a broken arm. He reports that he broke his arm while working at his construction job. Which of the following programs would be most appropriate for him to use to cover the price of his medication?

A)Medicare
B)Medicaid
C)His friend's insurance
D)Workers compensation

Answer 3

Workers compensation

Question 4

A 25 year old low-income patient with diabetes comes to your pharmacy seeking advice on what insurance program would be most beneficial to him. What program would you suggest?

A)Medicare
B)Workers compensation
C)Medicaid
D)No insurance coverage would be helpful

Question 5

Which of the following patients would qualify for Medicare coverage?

A)A 25 year old patient with alopecia
B)A 60 year old patient with hypertension
C)A 55 year old patient with fibromyalgia
D)A 70 year old patient with diabetes

Question 6

A 70 year old patient would like to obtain Medicare coverage for his prescription medications. What component of Medicare does he need to sign up for?

A)Medicare Part A
B)Medicare Part B
C)Medicare Part C
D)Medicare Part D

Question 7

Which of the following types of insurance coverage would be most appropriate for a patient who is active in the US military, who is filling a prescription at your pharmacy?

A)Medicare
B)Tricare
C)Medicaid
D)Workers compensation

Question 8

Which of the following programs is designed to provide financial assistance to patients who have been injured while at work?

A)Medicare
B)Medicaid
C)Tricare
D)Workers compensation

Question 9

Which of the following would be of assistance to a 28-year old patient who was in the military but is no longer on active duty after being honorably discharged?

A)Tricare
B)The Veterans Administration
C)Medicare
D)Medicaid

Question 10

Which of the following terms would describe a program designed by a drug company to help patients pay for one, specific, expensive medication?

A)Patient-assistance program
B)Workers compensation
C)Veterans Administration
D)Medicaid

Question 11

Which of the following terms describes when insurance companies require that specific criteria are met before they will consider paying for a patient's prescription medication?

A)Prior authorization
B)DAW code
C)Referral
D)BIN number

Question 12

What is the typical turnaround time for an insurance company to approve a prior authorization?

A)15 minutes
B)Up to 7 business days
C)14 business days
D)30 business days

Question 13

Why do insurance companies require prior authorizations for certain medications?

A)To prevent the patient from getting the medication they need
B)To ensure patients are treated with the most cost effective treatment option
C)To increase the cost the patient must pay out of pocket
D)To irritate the doctor's office staff

Question 14

Which of the following most accurately describes a prior authorization?

A)When a patient's insurance company requires that the patient meets specific criteria before they will consider paying for a patient's prescription medication, the process of documenting that these criteria have been met by the doctor's office is called prior authorization
B)When a patient is trying to fill a prescription for Acutance, this is the process the pharmacy must complete to obtain authorization to fill the prescription
C)When a patient has run out of refills on their medication, this is the process the pharmacy must complete to obtain refill authorization from the doctor's office
D)When a doctor wants to call in a prescription, this is the process they must go through in order to leave a voicemail for the pharmacist

Question 15

A doctor's office calls to say that they have completed the paperwork required by an insurance company to obtain prior authorization, but when you process the prescription through the insurance company's database, it still shows that it is not covered. What step has most likely not been completed?

A)The patient has not brought the prescription to the pharmacy
B)The doctor's office has not documented the patient's previous treatments
C)The insurance company has not yet approved the patient's prior authorization request
D)The pharmacy has not sent the paperwork to the doctor's office to be filled out

Question 16

A patient brings in a prescription for a brand name nasal steroid, which requires prior authorization in order to be covered by their insurance company. What is the first step that needs to be completed for the prior authorization to be approved?

A)Call the insurance company
B)Contact the doctor's office to inform them of the need for prior authorization and explain what they need to do to obtain approval for this medication
C)Tell the patient their medication isn't covered
D)Reprocess the claim to see if the need for prior authorization goes away

Question 17

When a prescription is written for a brand name medication, which of the following DAW codes describes when a prescriber does not allow a generic medication to be substituted for a brand name medication?

A)DAW 0
B)DAW 1
C)DAW 2
D)DAW -1

Question 18

Which of the following DAW codes should you submit to an insurance company when a patient requests a specific brand of medication be dispensed?

A)DAW 0
B)DAW 1
C)DAW 2
D)DAW -1

Question 19

If a patient does not have their insurance card, but knows the name of their insurance company, what can you do to obtain their insurance information?

A)Tell the patient they should go to their insurance company's website to get their insurance information
B)Call the patient's insurance company to obtain the patient's insurance information
C)Tell the patient to call their insurance company to obtain their insurance information
D)All of the above

Question 20

A patient asks you to call her insurance company to obtain her new identification number for her insurance plan. What information should you have available when calling the insurance company?

A)The patient's date of birth
B)The patient's last name
C)The patient's first name
D)All of the above

Question 21

How can you verify that a patient has coverage with an insurance company?

A)Call the company to verify coverage
B)Try to bill the insurance company for a prescription the patient wants to have filled
C)Check on the insurance company's website to verify coverage, if they have one available for this purpose
D)All of the above

Question 22

What pieces of information would you need to bill a patient's prescription to their insurance company, if they have prescription insurance coverage?

A)BIN number
B)ID number
C)Group number
D)All of the above

Question 23

Which of the following terms can be used to describe the amount of money a patient is responsible for paying for a medication after the insurance company has paid their share?

A)Co-payment
B)Cash price
C)Prior authorization
D)Average wholesale price

Question 24

Which of the following choices accurately describes a fixed co-payment for a prescription medication?

A)The patient pays a pre-determined percentage of the medication cost
B)The patient pays the entire cost of the medication being filled
C)The patient pays a variable amount of the medication cost, depending on the medication
D)The patient pays a set amount of money for each medication filled

Question 25

Which of the following terms describes a predetermined amount of money a patient must pay before an insurance company will cover expenses for additional services?

A)Co-payment
B)Deductible
C)Average wholesale price
D)Prior authorization

Question 26

Which type of co-payment occurs when a patient has to pay a specific percentage of the cost of a medication?

A)Fixed co-payment
B)Variable co-payment
C)Percentage co-payment
D)Specific co-payment

Question 27

Which of the following terms describes a type of co-payment in which the patient pays a set price for their medications?

A)Fixed co-payment
B)Variable co-payment
C)Percentage co-payment
D)Specific co-payment

Question 28

Which of the following most accurately reflects the cost a patient has to pay in order to obtain a prescription medication from a pharmacy?

A)Average wholesale price
B)Cash price
C)Medication cost + fee for dispensing
D)Medication cost - fee for dispensing

Question 29

Joe Smith last filled his prescription for a 30 day supply of zolpidem, 10mg using his insurance, on 11/2/12. Today is 11/7/12, and he would like to fill the prescription again. What rejection message is the insurance company most likely going to respond with?

A)Prior Authorization required
B)Refill too soon
C)Missing/invalid birth date
D)Filled after coverage terminated

Question 30

On January 1, Mrs. Smith tries to fill her prescription for Januvia. Her insurance company returns the claim as paid, but with a very high co-payment, even though the last time she bought it in December it had a $10 co-payment. What is most likely the reason for this?

A)The price for Januvia went up drastically
B)Her insurance has been terminated
C)Januvia is limited in availability so the price has increased
D)She has not yet met her deductible for the New Year

Question 31

A new patient tries to fill a prescription on their insurance, and the insurance company rejects the claim with the message "Missing/Invalid Birthdate." You verify that you have the patient's correct birthdate in the computer. What can you do?

A)Tell the patient that the insurance company won't pay for their medication
B)Tell the patient they have to pay out of pocket for their medication and submit the receipt to the insurance company for reimbursement
C)Call the patient's insurance company to see what birthdate they have on file
D)Make up a different birthdate for the patient

Question 32

Leslie is going on vacation for two months in 3 days. She last bought a 30 day supply of Cymbalta on 1/12/12. It is now 1/18/12, and she needs the medication for use while on her trip. What should you ask from the insurance company to get coverage for this extra supply of medication?

A)Lost medication override
B)Stolen medication override
C)Vacation override
D)Prior authorization

Question 33

What does the rejection message "Refill too soon" mean?

A)The patient's insurance coverage has not yet started
B)The patient's birthdate does not match with the insurance company's records
C)It is too early for the patient to receive another fill of medication based on their most recent prescription date
D)Authorization needs to be completed by the doctor's office to obtain insurance approval

Question 34

Which of the following is not a reason to receive a "Missing/Invalid Cardholder ID" rejection message when submitting a claim to an insurance company?

A)The patient's insurance coverage has ended
B)The patient has been issued a new identification number
C)The patient's ID number was typed into the pharmacy computer incorrectly
D)Prior authorization is needed to obtain coverage for the medication submitted

Question 35

A patient brings you their insurance information, and you try to submit it to the insurance company to bill a claim, but you find that you are missing some information. What pieces of information do you need to have, in order to get a claim paid by the insurance company?

A)BIN number
B)Patient's identification number
C)Group number
D)All of the above

Question 36

You try to bill a claim for a patient's medication, and the insurance company responds with the rejection message "Missing/Invalid ID Number." What can you do?

A)Call the insurance company to verify the ID number
B)Ask the patient if they have a new insurance card
C)Tell the patient they can call the insurance company to get their ID number
D)Any of the above

Question 37

You attempt to fill a refill prescription for Robert Smith, but when you try to bill the insurance company, you get the rejection message: "Filled After Coverage Terminated." What should you do?

A)Tell the patient that their coverage has terminated, and ask them to bring in their new insurance information, if they have it
B)Tell the patient you cannot fill prescriptions for him at your pharmacy anymore
C)Tell the patient his prescription is expired, and that you need to call the doctor for authorization to refill it
D)Tell the patient that the doctor has to provide authorization to the insurance company to refill it

Question 38

You attempt to refill a prescription for hydrochlorothiazide for a patient. You don't have the medication in stock, but plan to order it for the next business day. However, when you bill the insurance, you receive a rejection message of: "Discontinued NDC". What should you do?

A)Tell the patient that the insurance no longer covers their medication
B)Check with your wholesaler to see if there are any other NDC numbers available for the patient's medication
C)Refuse to sell the medication to the patient
D)Call your company's help desk

Question 39

One of your patients is blind, and prefers that her pills look the same each month, because she recognizes each pill by its shape, and feel. When you bill a refill for her Synthroid to her insurance after New Year's Day, it is rejected. What DAW code can you use to try to get her insurance to cover her medication?

A)DAW 0
B)DAW 1
C)DAW 2
D)DAW 3

Question 40

Which of the following rejection messages is most likely to appear if a patient's insurance is no longer active?

A)Refill Too Soon
B)Missing/Invalid Birthdate
C)Filled After Coverage Termination
D)Discontinued NDC Number

Question 41

Which of the following organizations may pay for durable medical equipment?

A)Medicare
B)FDA
C)DEA
D)None of the above