test 5

Question 1

what refers to both private health benefit programs and government-run programs that pay for prescriptions on behalf of patients?

Answer 1

third party programs

Question 2

what are the three parties involved in third party programs

Answer 2

The Patient, The pharmacy ,and Insurer

Question 3

What is the major difference between Health Maintenance Organizations (HMO’s) and Preferred Provider Organizations (PPO’s)?

Answer 3

HMO’s: Generally restrict patients from using providers not in their networkPPO’s: Allow patients to see providers out side of their network

Question 4

What are Pharmacy Benefit Manager (PBM’s) main administrative services related to pharmacy

Answer 4

Contract pharmacies to provide specified services
Reimburse pharmacies
Audit pharmacies
Process claims submitted by pharmacies

Question 5

Which groups of individuals do Medicare provide coverage?

Answer 5

Individuals with disabilities
People age 65+

Question 6

What is a form of patient cost sharing that requires patients to pay a specified percentage of their prescription expences

Answer 6

Coinsuence

Question 7

What is a form of patient cost sharing that requires patients to pay a specified dollar amount for every prescription receved

Answer 7

Copayment

Question 8

What is a plan that only covers prescription expenses after the patient has paid a specified dollar amount out of pocket

Answer 8

Deductible

Question 9

The total reimbursement for a medication is 50$ and the patient is respocable to pay 20% coinsurence what amount is payed by the PBM.

Answer 9

40$

Question 10

What are all of the patient details on a typical insurance card

Answer 10

BIN Bank Identification Number
PCN Processer Control Number
Group number
Expiration Date
Patient Name
Person Code
dependents
ID Number
Date of birth
Insurance Name
Copayment Amount

Question 11

Why do Pharmacy benefit Managers create lists of medications that are covered or excluded form coverage?

Answer 11

To control prescription cost

Question 12

Why is it important for a Pharmacy Technician to follow procedures relating to partial fills?

Answer 12

To avoid charging the Pharmacy benefit manager (PBM) twice

Question 13

What happens if a medication is not picked up by the patient within a specified period?

Answer 13

Medication is put back on the shelf, and third party or patient’s charge is reversed through claims reversal.

Question 14

What is a 6 digit number that the pharmacy uses to identify which insurance provider should receive the claim

Answer 14

BIN#: Bank Identification number

Question 15

What is an additional identifier that can be used to route prescription claims

Answer 15

PCN#: Processor control number

Question 16

What identifies the specific benefits plan for the member.

Answer 16

Group Number

Question 17

Using the wrong what can result in incorrect reimbursement rates or cause audit problems later

Answer 17

NDC Number

Question 18

What is a list of medications that are covered

Answer 18

Positive formulary

Question 19

What is a list of medications that are not covered

Answer 19

Negative formulary

Question 20

What is a company that buys products from manufacturers and other manufactures and sells these to pharmacies

Answer 20

Wholesalers

Question 21

Most pharmacies have a primary wholesaler, known as a what, that they take daily orders from

Answer 21

Primary vendor

Question 22

What is created to ensure that a group of pharmacies gets the best prices by allowing them to purchase their products in bulk

Answer 22

A GPO group purchasing organization

Question 23

What identifies the minimum number of units on hand that triggers a replenish order

Answer 23

A reorder point

Question 24

What is the number of units that must be ordered to replenish the inventory to optimum level with out going over. Based on usage and the amount of time it takes to receive the order.

Answer 24

the reorder quantity

Question 25

What is is an order-entry device that places an order by scanning the products NDC# and entering the quantity

Answer 25

A barcode reader

Question 26

As a first step, a Pharmacy technician must verify on the invoice that the number of what matches the number of what shipped

Answer 26

Totes received totes shipped

Question 27

Place what in an area that is designated by a pharmacist

Answer 27

Completed Invoices

Question 28

What are invoiced separately and should ALWAYS be checked in by a pharmacist

Answer 28

Controlled Substances

Question 29

As a pharmacy tech restocks the shelves with incoming orders from the supplier, they should do what by putting new bottles at the back and old bottles in the front

Answer 29

Rotate stock

Question 30

A pharmacy tech should learn the medications on the what or “Fast movers” first because the account for a significant percentage of all prescriptions dispensed

Answer 30

Speed shelf

Question 31

What or what merchandise can be returned to the supplier ,and there are a variety of methods of doing so

Answer 31

expired or unwanted

Question 32

what are three reasons the medications may be retuned to the manufacturer

Answer 32

Merchandise was
ordered by error
Expired merchandise
Recalled

Question 33

The pharmacy department efficiency depends on it being kept

Answer 33

organized and well stocked

Question 34

The drop off window must have what and be free of clutter

Answer 34

clean countertops

Question 35

Most pharmacies return any unclaimed prescription to stock after how long

Answer 35

7-10 Days

Question 36

Once a report is generated to note which prescriptions need to be deleted from the system, the procedure for returning them include that prescriptions are :

Answer 36

1. Pulled from the will call bin
2. Retuned to stock
3. Deleted from system
4. Insurance claim is reversed