Deck 13: Pharmacy Stock and Billing

Question 1

In the past decade,there has been a decline in "me-too" drugs.

Answer 1

False
In the past decade,there has been an explosive increase in the manufacture of "me-too" drugs.

Question 2

PPO is preferred provider organization.

Answer 2

True
PPO indicates preferred provider organization

Question 3

A formulary is analogous to a backbone.

Answer 3

True
A formulary is analogous to a backbone.

Question 4

There is open enrollment for Medicare plans each year from November 15th to ____ 31st.

A)November
B)December
C)January
D)March

Question 5

Brand name drugs generally have between 17 and 20 years before patents expire.

Question 6

Medicare services were broadened in 1980 with the creation of the ____ plan.

A)HMO
B)Medicare Modernization Act
C)PPO
D)Medigap

Question 7

Third-party billing refers to the portion of payment the customer pays.

Question 8

Medication is sent back to the warehouse or manufacturer for which of the following reasons?

A)Drug recall
B)Expired stock
C)Damaged stock
D)All of the above

Question 9

In 1966 more than ____ million people enrolled in the newly formed Medicare program.

A)12
B)17
C)19
D)15

Question 10

Both Medicaid and Medicare were implemented in:

A)1965
B)1975
C)1985
D)1995

Question 11

HMO stands for Homeopathic Medicinal Organization.

Question 12

Medicare is a health insurance program for people of what age and older?

A)75
B)56
C)57
D)65

Question 13

Following Health Insurance Portability and Accountability Act (HIPAA)regulations in ____,the pharmacy does not have access to information regarding reason for insurance rejection and is disclosed only a termination date.

A)2001
B)2005
C)2003
D)2007

Question 14

A significant change was made in ____ with the passage of the Medicare Modernization Act (MMA).

A)2000
B)2003
C)2006
D)2009

Question 15

When patients are disposing of unused medications,for many drugs it is advisable to mix them with ____ and then place them in the garbage.

A)Rubbing alcohol or hydrogen peroxide
B)Coffee grounds or kitty litter
C)Water or juice high in citric acid
D)Any and all of the above

Question 16

Pharmacy technicians are not allowed to assist in the third-party billing process.

Question 17

In general,technicians only need to be aware of the type of insurance (as far as HMO vs PPO)when Medicare is involved.

Question 18

Individuals must be 65 years or older,be younger than 65 with long-term disabilities,or suffer from end-stage renal disease in order to receive coverage from Medicare government-managed insurance.

Question 19

If a patient has HMO insurance the pharmacy bills the ____ first.

A)Insurance company
B)Hospital
C)Pharmacist
D)Patient

Question 20

Formulary drugs are as effective as the brand name drugs.

Question 21

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
Red Book

Question 22

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
Adjudication

Question 23

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
Treatment authorization request (TAR)

Question 24

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
Closed formulary

Question 25

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
Formulary

Question 26

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
National Provider Identifier (NPI)

Question 27

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
Open formulary

Question 28

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
National Drug Code (NDC)

Question 29

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
Medicare Modernization Act (MMA)

Question 30

Match the term with the correct definition.
a.Reference book listing NDC numbers, manufacturers, and average wholesale pricing of drug products
b.Electronic insurance billing for medication payment
c.Number assigned to health care provider; used for the purpose of standardizing health data transmissions
d.A list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and then reimbursed under the health provider plan or pharmacy benefit plan
e.Medication use is tightly restricted to those medications provided on the list
f.Sets limitations on payments
g.A list of preapproved medications that are covered under a prescription plan or within an institution
h.Similar to a preauthorization form but is the process used for Medicare and Medicaid
i.Information sheets supplied to the pharmacy from the manufacturer of chemical products that list hazards and how to handle them if exposed to the chemicals
j.Ten-digit number given to all drugs for identification purposes; in health and drug databases
Material safety data sheets (MSDS)