Reimbursement Methodologies

20 Questions

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Outdated billing software showing outdated codes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)

 

What’s one of the functions served by PBMs?

Question 11 options:

A) 

They protect pharmaceutical companies from being the target of legal action.

B) 

They don’t work closely with insurance companies.

C) 

They ensure that medical insurance companies operate within the law.

D) 

They perform drug utilization reviews.

Question 12 (5 points)

 

What method of reimbursement do most pharmacies use?

Question 12 options:

A) 

Point of sale

B) 

Fee-for-service plan

C) 

Retrospective plan

D) 

Prospective plan

Question 13 (5 points)

 

What’s one of the services provided by a home health agency (HHA)?

Question 13 options:

A) 

Medication disbursement

B) 

Comprehensive hospital care

C) 

24-hour nursing coverage

D) 

Speech therapy

Question 14 (5 points)

 

What type of reimbursement will increase the reimbursement rate if the costs of the healthcare provider increase?

Question 14 options:

A) 

Capitation

B) 

Episode-of-care reimbursement

C) 

Prospective payment system

D) 

Fee-for-service reimbursement

Question 15 (5 points)

 

What does the acronym APC stand for?

Question 15 options:

A) 

Ambulatory pre-assistance care

B) 

Assisted preventive care

C) 

Ambulatory payment classification

D) 

Assistance for postoperative care

Question 16 (5 points)

 

Medicare Part D covers what part of Medicare?

Question 16 options:

A) 

Physician and outpatient care

B) 

Prescription drug coverage

C) 

Medical reimbursement

D) 

Hospital care

Question 17 (5 points)

 

Medical expenses covered under a patient’s insurance plan are paid by the

Question 17 options:

A) 

third-party payor.

B) 

sponsor.

C) 

beneficiary.

D) 

insurance broker.

Question 18 (5 points)

 

What’s one of the most common reasons for a claim being rejected by an insurance company?

Question 18 options:

A) 

The patient is outside of the age group that is specified for the medication.

B) 

The patient’s insurance information has been entered incorrectly.

C) 

The prescribing physician is out of the patient’s network.

D) 

The medication prescribed isn’t the correct treatment for the patient’s condition.

Question 19 (5 points)

 

Which payment system was originally developed by the US federal government specifically for Medicare?

Question 19 options:

A) 

Retrospective payment

B) 

Historical payment

C) 

Global payment

D) 

Prospective payment

Question 20 (5 points)

 

A _______ cost for a given condition is a measure of how much people paid in the past to treat it.

Question 20 options:

A) 

homecare

B) 

historical

C) 

prospective

D) 

physician