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Question:

Which answer is not a reason a claim can be rejected?

A address of patient

explanation

Currently, third-party payers do not cross-reference a patient's address. They do check on gender, date of birth, and name.

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When a worker is injured, which program may provide medical and prescription benefits to qualified workers?

workers' compensation

Workers' compensation programs provide medical and prescription benefits for injured workers. Benefits received will depend on state laws.

Which is usually not found on a patient's prescription card?

date of birth

Besides a patient's name, the prescription card does not have any identifiable information like date of birth or social security number.

What term refers to the processing of a prescription claim to a third-party provider?

Online adjudication

Online adjudication is the electronic billing process for a prescription covered by a pharmacy benefits manager. The banking identification number (BIN) and the group number are pieces of information found on a prescription drug card. A rejection code is provided to the pharmacy to explain why a prescription claim was rejected.

What is the markup rate for a drug that costs $19.99 and retails for $25.99?

30%

Answer = 30%. Markup rate is the markup dollars divided by the cost times 100. Calculate the markup: Retail price ($25.99) - Cost ($19.99) =$6.00. Divide the markup dollars ($6.00) by the cost ($19.99) and multiply by 100: ($6.00/$19.99) X 100 = 30%.

What will the inventory turnover rate be for a pharmacy if the inventory value is $255,000 and the pharmacy has sales of $3 million?

11.76

Answer = 11.76. Inventory turns can be calculated by dividing total sales by the inventory value or the average inventory value. Sales ($3,000,000)/ Inventory ($255,000) = 11.76 inventory turns.

Which of the following groups does Medicare not cover?

Children

Medicare does not cover children.

What term refers to a type of health care reimbursement plan in which the participant may make pre-tax contributions through payroll deductions to pay for prescription copays, prescriptions, and prescription deductibles?

Health care saving plans

Health care saving plans were created under the Medicare Modernization Act of 2003, which allows individuals to set aside money from their paychecks to be used for medical purposes in a calendar year. This money is tax deductible, but there are limits to how much may be deducted, and if the money is not used during the calendar year, it is forfeited.