<p>Pharmacy Billing and Reimbursement PTCB Practice Test</p><p>1. Which government insurance plans offers 4 different parts or areas of different coverage?</p><p>A. Medicare</p><p>B. Medicaid</p><p>C. TRICARE</p><p>D. CHAMPVA</p><p>2. DAW stand for which of the following?</p><p>A. Dispense as written</p><p>B. Distribute and work</p><p>C. Distribution and working</p><p>D. Dispense as well</p><p>3. Which of the following third party plans requires the patient to designate a primary care physician (PCP)?</p><p>A. Health maintenance organization (HMO)</p><p>B. Preferred provider organization (PPO)</p><p>C. Medicare Part D D. TRICARE</p><p>4. The cost of the coverage of an insurance policy is known as which of the following?</p><p>A. Deductible </p><p>B. Co-payment</p><p>C. Coinsurance</p><p>D. Premium</p><p>5. Which of the following is another name for the cardholder of the insurance policy?</p><p>A. Subscriber</p><p>B. Dependent</p><p>C. Patient</p><p>D. Third party</p><p>6. When a patient picks up a prescription in the pharmacy, he or she may be responsible for an out-of-pocket expense known as which of the following?</p><p>A. Co-payment</p><p>B. Premium</p><p>C. Deductible</p><p>D. Third party 7. The part of Medicare that covers the costs of prescriptions for Medicare patients is known as which of the following?</p><p>A. Part A</p><p>B. Part B</p><p>C. Part C</p><p>D. Part D</p><p>8. Which organization oversees Medicaid and Medicare?</p><p>A. Food and Drug Administration (FDA)</p><p>B. Drug Enforcement Agency (DEA)</p><p>C. Centers for Medicare and Medicaid Services (CMS)</p><p>D. United States Pharmacopeia (USP)</p><p>9. Which of the following is a formulary?</p><p>A. A list of insurance companies that offer pharmacy benefits</p><p>B. List of providers that are included in an HMO</p><p>C. List of approved medications in a member’s plan</p><p>D. Recipe for how to make specific medications</p><p>10. If a drug is not covered under a patient’s prescription plan, but the prescriber specifically wants the patient to have this medication, the insurance company may require which of the following? A. Formulary</p><p>B. Prior authorization</p><p>C. Adjudication</p><p>D. Coordination of benefits</p><p>11. Which code is used for the third party to determine if the proper brand or generic medication was used to fill the prescription?</p><p>A. USAN</p><p>B. DAW</p><p>C. Adjudication</p><p>D. Trade</p><p>12. Which of the following DAW code is submitted when a generic drug is dispensed or a brand name product that does not have a generic available?</p><p>A. DAW 0</p><p>B. DAW 1</p><p>C. DAW 2</p><p>D. DAW 3</p><p>13. After a claim has been submitted, what is the process of evaluating a medication for specific drug safety and cost-effectiveness measures known as? A. Coordination of benefits</p><p>B. Drug utilization review</p><p>C. Prior authorization</p><p>D. Coinsurance</p><p>14. The deductible is the amount that must be paid when?</p><p>A. Each time when prescription is picked up</p><p>B. Each year before the policy kicks in</p><p>C. Monthly to cover the insurance plan</p><p>D. As a percentage of the cost of services</p><p>15. If a patient has coinsurance that pays 90% of services, and their prescription cost $50, how much will they owe the pharmacy?</p><p>A. $5</p><p>B. $10</p><p>C. $15</p><p>D. $25</p><p>16. Which of the following is an example of a third party plan?</p><p>A. HOM</p><p>B. Prior authorization</p><p>C. Adjudication</p><p>D. Premium 17. Which of the following is an example of a private insurance company?</p><p>A. Medicare</p><p>B. Medicaid</p><p>C. TRICARE</p><p>D. Aetna</p><p>18. A patient pays a $500 deductible and a total of $100 in co-pays for the year. The total $600 is called which of the following?</p><p>A. Premium</p><p>B. Out-of-pocket expenses</p><p>C. Coinsurance</p><p>D. Point-of-service</p><p>19. CMS represents which organizations?</p><p>A. TRICARE and Medicare</p><p>B. Medicare and Medicaid</p><p>C. TRICARE and CHAMPVA</p><p>D. CHAMPVA and Medicare</p><p>20. To ensure that the maximum benefits are paid, but not duplicated, patients covered under multiple insurance plans will undergo which of the following? A. Adjudication</p><p>B. PCN</p><p>C. PBM</p><p>D. Coordination of benefits</p><p>21. Which of the following DAW code is submitted when the patient requests a brand name product, although the prescriber says generic substitution?</p><p>A. DAW 1</p><p>B. DAW 2</p><p>C. DAW 3</p><p>D. DAW 5</p><p>22. Which of the following information must be gathered from the patient to process an insurance claim?</p><p>A. First and last name</p><p>B. Birthdate</p><p>C. Drug allergy information</p><p>D. All of the above</p><p>23. Which of the following might have a person number of 3?</p><p>A. Member B. Spouse of member</p><p>C. Child of member</p><p>D. None of the above</p><p>24. PCN stands for which of the following?</p><p>A. Patient-controlled narcotics</p><p>B. Processor control number</p><p>C. Pharmacy control number</p><p>D. Patient-centered number</p><p>25. Which of the following is required to submit an insurance claim?</p><p>A. Rx Bin number</p><p>B. Rx Group number</p><p>C. Patient ID number</p><p>D. All of the above</p><p>26. What type of pharmacy would pay for a 90-day supply of medication?</p><p>A. Retail</p><p>B. Mail-order</p><p>C. Nuclear</p><p>D. Long-term care 27. When is a prior authorization required?</p><p>A. A patient is going on vacation</p><p>B. A patient has a change in dosage</p><p>C. A patient has a prescription for an expensive medication or one not on the formulary</p><p>D. A patient only wants a generic drug</p><p>28. Which of the following might cause a refill-too-soon rejection?</p><p>A. A patient attempts to refill their prescription before the insurance company permits a scheduled fill</p><p>B. A patient is going on vacation, and attempts to get a larger quantity than normal</p><p>C. A patient had an increased dosage by their physician, and is taking a larger quantity than before so they run out before the scheduled refill date</p><p>D. All of the above</p><p>29. If a DAW 0 was used, what does this mean?</p><p>A. The prescriber wants a name brand dispensed</p><p>B. The generic is dispensed or brand name only if there is no generic available</p><p>C. The pharmacist wants the patient to have the brand name</p><p>D. There is no generic available due to manufacturing or distribution issues 30. A patient is taking an antacid while also on a tetracycline antibiotic. The antacid will cause the antibiotic to cease working. This is an example of which type of DUR rejection?</p><p>A. Drug-drug interaction</p><p>B. Therapeutic duplication</p><p>C. Allergy</p><p>D. Contraindication</p><p>31. In a PPO, if a patient wants to see a specialist, they must do which of the following?</p><p>A. Get a referral from their primary care physician</p><p>B. Get approval from the pharmacy</p><p>C. See any provider as long as they are in network</p><p>D. None of the above</p><p>32. Coinsurance is similar to a co-payment, except patients do not pay a flat fee for prescriptions but a ______</p><p>A. Premium</p><p>B. Cheaper cost</p><p>C. Variable rate</p><p>D. Percentage of the cost</p><p>33. Which of the following would not be covered under Medicare Part A? A. Inpatient hospital stays</p><p>B. Prescription drugs</p><p>C. Hospice care</p><p>D. Home health care services</p><p>34. In order to be enrolled in Medicare Part C, a patient must be enrolled in which of the following Medicare parts?</p><p>A. Parts A and B</p><p>B. Parts A and D</p><p>C. Parts B and D</p><p>D. None of the above</p><p>35. Which of the following would Medicare Part D not cover?</p><p>A. DME</p><p>B. Lipitor</p><p>C. Lisinopril</p><p>D. Zetia</p><p>36. A patient learns that a medication the doctor has prescribed is not on the approved list of drugs covered by her insurance company. What is this list of drugs called?</p><p>A. Adjudication</p><p>B. Coordination of benefits C. Pharmacy benefit manager</p><p>D. Formulary</p><p>37. Most patients enroll in private health care plan through contracts offered by which of the following?</p><p>A. The pharmacy</p><p>B. The insurance company</p><p>C. Their employer</p><p>D. None of the above</p><p>38. If a patient’s services cost a total of $100, and they are responsible for 20% of the costs, this is known as which of the following?</p><p>A. A co-payment</p><p>B. A deductible</p><p>C. A premium</p><p>D. Coinsurance</p><p>39. Which part of Medicare covers DME and physician services or outpatient hospital visits?</p><p>A. Part A</p><p>B. Part B</p><p>C. Part C</p><p>D. Part D 40. A pharmacy benefit manager processes and pays for drug claims for which of the following?</p><p>A. One insurance provider</p><p>B. Multiple insurance provider</p><p>C. Multiple pharmacies</p><p>D. One pharmacy</p><p>41. How many numbers is the BIN number on each insurance card?</p><p>A. 3</p><p>B. 4</p><p>C. 5</p><p>D. 6</p><p>42. If a patient has had his or her coverage terminated, what restricts the pharmacy from accessing information about why the patient no longer has coverage?</p><p>A. DEA</p><p>B. HIPAA</p><p>C. FDA</p><p>D. State laws</p><p>43. When does a refill-too-soon error occur? A. A patient attempts to get a 90-day supply of a medication</p><p>B. A patient attempts to get a name brand of a medication</p><p>C. A patient attempts to get their prescription filled before the insurance company permits a scheduled fill</p><p>D. A prior authorization is needed</p><p>44. You are filling a prescription for a patient who insists on getting the brand name medication. What DAW code would this be?</p><p>A. DAW 0</p><p>B. DAW 1</p><p>C. DAW 2</p><p>D. DAW 3</p><p>45. DUR stands for which of the following?</p><p>A. Drug utilization remission</p><p>B. Drug utility recess</p><p>C. Drug utilization review</p><p>D. Director utilization review</p><p>46. A PA is also known as which of the following?</p><p>A. Prior authorization B. Part A</p><p>C. Premium assistance</p><p>D. Pharmacy assistance</p><p>47. Which part of Medicare supplies patients with coverage for inpatient hospital stays and nursing facilities?</p><p>A. Part A</p><p>B. Part B</p><p>C. Part C</p><p>D. Part D</p><p>48. Which of the following is the Part D plan for Medicare?</p><p>A. Is a voluntary program for Medicare patients</p><p>B. Must be enrolled in during a designated period</p><p>C. Is very important for pharmacy technicians to be familiar with</p><p>D. All of the above</p><p>49. If a patient is pregnant, and given a medication that is a pregnancy class D, this would be considered what type of DUR rejection?</p><p>A. Drug-drug interaction</p><p>B. Therapeutic duplication</p><p>C. Allergy D. Contraindication</p><p>50. Which of the DAW code is submitted when the prescriber indicates he or she wants the brand name dispensed?</p><p>A. DAW 0</p><p>B. DAW 1</p><p>C. DAW 2</p><p>D. DAW 3</p>