Reimbursement Methodologies for Pharmacy

Reimbursement Methodologies for Pharmacy Technicians
Question 1 (5 points)
What is the definition of universal healthcare?
Question 1 options:
A)
Healthcare that’s provided globally as well as to U.S. citizens
B)
Healthcare that’s provided to all people without exception
C)
Healthcare that includes certain medical treatments, without limitations
D)
Healthcare that’s provided by an employer to an employee
Question 2 (5 points)
What does the acronym ASC stand for?
Question 2 options:
A)
Ambulatory state care
B)
Ambulatory surgery center
C)
Acute services center
D)
Assisted specialist care
Question 3 (5 points)
What is the name of the federal agency within the DHHS responsible for administering programs such as the Health Insurance Marketplace?
Question 3 options:
A)
Centers for Medicare and Medicaid Services (CMS)
B)
Health Insurance Initiative Program
C)
Children’s Health Insurance Program (CHIP)
D)
Medicaid Insurance and Health Organization
Question 4 (5 points)
Which of the following is a common reason for reimbursement mistakes?
Question 4 options:
A)
Outdated billing software showing outdated codes
B)
Loss of data
C)
Mistaken identity of patients
D)
Failure to process claims that were submitted
Question 5 (5 points)
What type of care is least complicated to bill?
Question 5 options:
A)
ER
B)
Inpatient pharmacy
C)
Pre-booked hospitalization
D)
Outpatient pharmacy
Question 6 (5 points)
What’s one type of episode-of-care reimbursement?
Question 6 options:
A)
PPS
B)
OPPS
C)
Global payment
D)
Point-of-sale
Question 7 (5 points)
What’s one of the goals set out by the Healthy People 2010 program?
Question 7 options:
A)
Ensuring that private hospitals accept payment from any health insurance company
B)
Eliminating the difference between the healthcare available to low- and high-income persons
C)
Encouraging all employers to provide health insurance to their employees
D)
Ensuring that complaints against unfair billing are addressed
Question 8 (5 points)
A patient has an outpatient procedure at a hospital and is given a prescription that’s filled at the hospital pharmacy. The bills for these services are sent to the patient’s health insurance provider, who then pays the hospital. This payment is best classified as
Question 8 options:
A)
settlement.
B)
compensation.
C)
reimbursement.
D)
remuneration.
Question 9 (5 points)
What’s the term given to the process of determining whether to approve a health insurance claim?
Question 9 options:
A)
Enquiring
B)
Adjudication
C)
Arbitration
D)
Reimbursement
Question 10 (5 points)
What’s one of the billing steps taken by the pharmacist in an outpatient pharmacy?
Question 10 options:
A)
The patient will pay out of pocket, and the pharmacist will give the patient a compensation letter which will allow them to be reimbursed by the insurance company.
B)
The prescription data, which includes the patient’s insurance information, is entered into the pharmacy’s software management system.
C)
The pharmacy will notify the prescribing physician who will then bill the insurance company for the service and for the medication they prescribed on behalf of the pharmacy.
D)
The pharmacist will submit the claim to the insurance company by phone.
Question 11 (5 points)

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