Chapter 5 Law: Medicare and Medicaid

Certain federal employees and former federal employees who are not eligible for Social Security benefits and Medicare Part A can still enroll in:

Part B

Anyone using prescription or nonprescription medications, herbals, or other dietary supplements can benefit from:

MTM services

Which part of Medicare supports medical insurance and physician services?

Part B

Which of the following individuals benefited from Medicare programs by the U.S. government?

Elderly

One of the most common claim rejections seen in the pharmacy is:

refill too soon

Which Medicare plan was passed in the year 2003?

Part D prescription drug plan

What are the preventable adverse events causing the government to incur $177 billion in costs every year?

Injury and death

What is the basis for the federal government to fund the states?

Per-capita income

The laboratory tests, surgeries, and doctor visits are referred to as:

medically necessary services

Most people who have Medigap are with:

low premium plans

What is the book of standards for certain pharmaceuticals and preparations?

National Formulary (NF)

Who conducts MTM?

Pharmacists

Which of the following is not classified under categorically needy of Medicaid?

a. Pregnant women and children under age 6 with a family at or below 133 percent of the FPL

b. Families who meet the Temporary Assistance for Needy Families eligibility

c. SSI recipients

d. Qualifying individuals, with income between 120 percent and 175 percent of FPL

d. Qualifying individuals, with income between 120 percent and 175 percent of FPL

Who needs to certify the drugs imported from Canada and certain other countries for consumption in the United States?

Department of Health and Human Services

When can the prescription be billed again for the medication supplied?

When about 85 percent of the medication has been used

What act has enabled employers to offer employee drug benefits through drug subsidies?

Medicare Modernization Act

The CMS-1500 is used for reimbursement from other government plans such as:

Tricare

What were the types of insurance that Medicare covered primarily?

Hospital and medical insurance

Which part of Medicare covers hospitalization?

Part A

Nonpreferred brand-name drugs are referred in:

Tier 3

Passive interventions do not include:

medication safety surveillance

Medically necessary services such as laboratory tests, surgeries, and doctor visits are covered under Medicare:

Part B

Identify the level under which the drugs that are rare and high in cost are classified.

Tier 4

The Part B of Medicare covers:

surgeries

What is needed to tackle public health problems like medication-related problems and medication mismanagement?

MTM

Which of the following type of drugs come with the black box warnings?

Formulary drugs

All people eligible for Medicare Part A can choose to enroll in Part B by paying:

monthly premium

What was the reason for the U.S. government to establish Medicare?

Lack of employment and insurance

Drug standards are contained in the

USP-NF

What kind of people are not included in Medicare program by just being citizens of the United States?

The poor

When a certain drug is not covered by an insurance plan, who is authorized to show that the nonformulary drug is medically necessary to a patient?

Physician

What word means accepting the Medicare approved amount as full payment by the provider against enrolling for preventive services?

Assignment

What is called a list of approved brand-name drugs available through a PDP?

Formulary

What controls the laws and regulations of Medicare program?

The federal government

Health insurers are not allowed to sell:

new Medigap policies

Categorically needy, medically needy, or special groups are classification of:

medically indigent people

When a company chooses to develop its own formularies, it must have a pharmacy and a committee of:

both pharmacists and physicians

When Medicare claims are filed, what forms must be used?

CMS-1500

Pharmacist-provided services that optimize therapeutic outcome for individual patients are:

Medication therapy management

Beneficiaries can change plans just once in:

a year