Deck 13: Pharmacy Billing and Inventory Management

Question 1

When a workers' compensation claim prescription is presented to the pharmacy, the technician should:

A)Fill it, and obtain permission from the government agency at a later time.
B)Obtain information from the patient's human resource department before filling.
C)Fill it, and collect full payment from the patient.
D)Wait until receiving payment from the insurance company before filling.

Answer 1

B
If the patient arrives at the pharmacy with a workers' compensation claim, then obtaining billing information before dispensing the medication, if possible, is important. This may involve contacting the patient's employer, obtaining the billing information over the telephone from the human resources department, and then calling the workers' compensation insurance company for further information.

Question 2

Which of the following insurance plans requires a PCP?

A)HMO
B)PPO
C)Medicaid
D)All of the above

Answer 2

A
An HMO is an insurance plan that allows coverage for in-network-only physicians and services and uses a PCP.

Question 3

The name a company assigns to a commercial drug product for marketing and identification purposes is called the _____________ name.

A)Trade
B)Brand
C)Proprietary
D)All of the above

Answer 3

D
The trade, brand, or proprietary drug name is the name a company assigns for marketing and identification purposes to a commercial drug product.

Question 4

Which of the following is not a government-managed program?

A)Medicare
B)Medicaid
C)TRICARE
D)Health maintenance organization (HMO)

Question 5

What is one method of medication disposal that patients should be discouraged from using?

A)Wrapping the medication in coffee grounds
B)Wrapping the medication in kitty litter
C)Flushing the medication down the toilet
D)All of the above

Question 6

Both Medicare and Medicaid were implemented in:

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

Question 7

The typical drugs included in a formulary are drugs that are:

A)New
B)Generic
C)Orphan
D)Extremely expensive

Question 8

Which of the following codes means that the physician has authorized a generic substitution?

A)Dispense as written (DAW) 0
B)DAW 1
C)DAW 2
D)DAW 3

Question 9

PPO means:

A)Preferred provider option
B)Preferred provider organization
C)Preferred physician option
D)Preferred physician organization

Question 10

Medicare Part D specifically covers:

A)Prescription medications
B)Surgery
C)Physicians' visits
D)Physical therapy

Question 11

Supplemental insurance provided through private insurance companies that help cover costs not reimbursed by Medicare is called:

A)Medigap plan
B)Medifill plan
C)Medisupp plan
D)Mediplus plan

Question 12

Some insurance policies require that the person pay a monthly:

A)Premium
B)Deductible
C)Copay
D)Stipend

Question 13

Point-of-sale (POS) billing allows the insurance company to:

A)Price a claim
B)Verify eligibility
C)Identify covered drugs
D)All of the above

Question 14

Which of the following types of patients would not be eligible for Medicare coverage?

A)Disabled patients
B)Senior citizens
C)Dialysis patients
D)Healthy babies

Question 15

Which of the following is not a reason for the insurance company to reject a claim?

A)Refill is requested too early.
B)Policy has expired.
C)Patient's identification does not match the processor's information.
D)Claim is a formulary medication.

Question 16

The amount to be charged to the insured patient for a prescription is decided by the ______________.

A)Pharmacy
B)Patient
C)Insurance company
D)None of the above

Question 17

Which one of the following is not a valid reason to return a medication to the warehouse or manufacturer for credit?

A)Drug was recalled
B)Drug expired
C)Drug was incorrectly reconstituted
D)Drug was damaged during delivery

Question 18

What is the meaning of AWP?

A)Allowable wholesale price
B)Average wholesale price
C)Average wholesale purchase
D)Acceptable wholesale price

Question 19

Which one of the following illnesses is the patient not exempt from insurance company limitations?

A)Diabetes
B)Acquired immunodeficiency syndrome (AIDS)
C)Human immunodeficiency virus (HIV)
D)Cancer

Question 20

Workers' compensation is paid for by:

A)State government
B)Federal government
C)Employers
D)Employees

Question 21

The processing of claims by insurance companies over a computerized system is called:

A)Adjudication
B)Adjustment
C)Computerization
D)Instant processing

Question 22

Which of the following is not true of flexible spending accounts?

A)The government limits the amount of money a person can put into these accounts each calendar year.
B)The money is there for as long as the person needs it.
C)Restrictions are placed on what services are covered.
D)The plans are similar to a savings account.

Question 23

A system that automatically tracks inventory is:

A)Ordering cards
B)Automatic dispensing systems (ADS)
C)Handheld inventory computers
D)Bar coding

Question 24

What is a PAR level?

A)Periodic automatic replacement
B)Periodic automatic replenishment
C)Periodic adjusted replacement
D)Positive automatic replenishment

Question 25

What is meant by stock rotation?

A)Moving medication shelf displays around the pharmacy to ensure maximum exposure
B)Selling out an item before replacing it
C)Bringing the items with the earliest expiration dates to the front so they are used first
D)Moving items to different places on the shelves

Question 26

The term third-party billing refers to the portion of payment:

A)Paid by the customer
B)Reimbursed by insurance companies
C)Paid by the pharmacy
D)All of the above

Question 27

The information needed by insurance companies to process a claim from the pharmacy or to reimburse the patient is the same as the information required on a pharmacy label, plus:

A)Patient's date of birth
B)Insurance group number
C)Insurance identification number
D)All of the above

Question 28

Which part of Medicare helps pay for physicians' services and outpatient care?

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

Question 29

What is meant by a back-ordered item?

A)The item is automatically replaced by the wholesaler on a weekly basis.
B)The item must be reordered since it did not arrive with the order.
C)The ordered item is not currently in stock but will be sent as soon as it is available.
D)The item has been discontinued.

Question 30

Which of the following is not a true statement about PPOs?

A)The copay is usually lower for an office visit than with an HMO.
B)PPOs may have an annual deductible.
C)PPOs do not require a PCP.
D)The patient may have to pay full price for the prescription and then send in the receipt for later reimbursement.

Question 31

An innovator product is a:

A)New generic drug
B)New medication shape
C)Drug product that was first patented and marketed by the owner or manufacturer
D)Brand name drug that is produced by a nonproprietary company

Question 32

Which of the following types of medication require special ordering, inventory, storage, handling, and return documentation?

A)Cytotoxic medications
B)Controlled substances
C)Investigational drugs
D)All of the above

Question 33

In which of the following circumstances do most insurance companies allow early refills?

A)Extended vacation
B)Disaster situation
C)Needing a backup supply
D)A and B