pharmacy practice : insurance & third party billing

What is Medicare primarily designed to provide coverage for?

Hospital and medical expenses

Medicare Part D specifically provides coverage for?

Prescription drugs

Who is eligible for Medicare benefits?

U.S. citizens and legal residents aged 65 and older

Medicaid is a government program that primarily provides health coverage for which patient population?

Low-income individuals and families

What is the main difference between Medicaid and Medicare?

Medicaid for low-income individuals, while Medicare is for the elderly

TRICARE is a health care program primarily designed for:

Active duty military personnel and their families

What is workers’ compensation?

A system that compensates employees for job-related injuries and illnesses

Which of the following injuries would typically be covered under workers’ compensation?

A back injury caused by lifting heavy boxes at work

What is the purpose of a deductible in insurance policies?

It’s the amount the insured person pays out of pocket before the insurance coverage kicks in

What does “copayment” mean in health insurance?

A fixed amount the insured person pays for certain medical services, while the insurance covers the rest

What does the Processor Bank Identification Number (BIN) help identify?

The specific third-party payer for electronic pharmacy claims.

on pharmacy practice insurance & 3rd party billing

cards

Which of these errors can lead to insurance billing rejections?

Incorrect name on the insurance claim.

What is the purpose of the adjudication process in pharmacy practice?

To transmit a prescription electronically for insurance or third-party approval and billing.

A pharmacy technician sees that a prescribed brand-name medication has a generic version available, which is covered by the patient's insurance. What should the technician do next according to proper procedure?

Check with the prescriber, and if they insist on the brand-name, use the "Dispense as Written" (DAW) code.