Pharmacy Billing and Reimbursement
Exam Preparation Guide
Course Introduction
Pharmacy Billing and Reimbursement covers the foundational principles and practices necessary for understanding the processes of billing and payment within the pharmacy sector. Students learn about third-party payers, including private insurance, Medicaid, and Medicare, as well as regulatory guidelines affecting pharmacy claims. The course addresses proper coding, claim submission, prior authorization procedures, and methods for resolving claim rejections and denials. Additionally, it explores strategies to optimize pharmacy reimbursement, the importance of accurate documentation, and the ethical considerations associated with billing processes.
Recommended Textbook
Mosby s Pharmacy Technician Principles and Practice 3rd Edition by Teresa Hopper BS CPhT
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31 Chapters
900 Verified Questions
900 Flashcards
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Chapter 1: History of Medicine and Pharmacy
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29 Verified Questions
29 Flashcards
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Sample Questions
Q1) Greek physician
A)Paracelsus
B)Asclepius
C)Gregor Mendel
D)Aristotle
E)Hippocrates
F)Roger Bacon
G)Galen
Answer: G
Q2) Who introduced the art of treating an illness with one medication at a time?
A)Galen
B)Hippocrates
C)Bacon
D)Paracelsus
Answer: D
Q3) Over the years,the technician's job description has remained the same.
A)True
B)False
Answer: False
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Page 3
Chapter 2: Pharmacy Federal Laws and Regulations
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Sample Questions
Q1) The definition of confidentiality is to keep privileged information about a customer from being disclosed without his or her consent.
A)True
B)False
Answer: True
Q2) The Harrison Narcotic Act was enacted in which year?
A)1912
B)1913
C)1914
D)1915
Answer: C
Q3) In which year was the Durham-Humphrey Amendment enacted?
A)1871
B)1991
C)1891
D)1951
Answer: D
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Page 4
Chapter 3: Pharmacy Ethics, competencies, associations, and Settings for Technicians
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28 Flashcards
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Sample Questions
Q1) AAPT
A)Pharmacy association primarily for technicians founded in 1999
B)Offers certifications in 14 different health care fields
C)State-managed agency that licenses pharmacists and technicians
D)Oldest pharmacy association; founded in 1852
E)National organization for members of state boards of pharmacy
F)First pharmacy technician association; founded in 1979
G)Pharmacy association founded in 1942
H)National board for the certification of pharmacy technicians
I)Recognition given to a technician who passes the PTCB or ICPT
Answer: F
Q2) Closed door pharmacies are not open to the public.
A)True
B)False
Answer: True
Q3) Competency is the ability to express oneself in such a way that one is readily and clearly understood.
A)True
B)False
Answer: False
Page 5
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Chapter 4: Conversions and Calculations Used by Pharmacy Technicians
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Sample Questions
Q1) A recommended dose for the administration of a drug is 22 mg/kg/day.How many milligrams of this drug must be administered per day to a 220 lb adult? ____Â mg
A)2200
B)10
C)4840
D)10648
Q2) MMMXXXVII = ____
A)3037
B)3307
C)137
D)337
Q3) A patient is to receive 405 ml of an IV infusion over a period of 9 hours.The IV set is calibrated to deliver 4 gtt/ml.How many drops per minute should the patient receive? ____Â gtt/min
A)2
B)180
C)11.25
D)3
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Chapter 5: Dosage Forms, routes of Administration and
Drug Classifications, drug Abbreviations, and Medical
Terminology
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Sample Questions
Q1) Ampules can range in volume from 0.5 to ____ ml.
A)1
B)50
C)5
D)500
Q2) None of the abbreviations that are used in prescribing medication look very much alike.
A)True
B)False
Q3) Suspension dosage forms are also formulated to be used:
A)Topically, vaginally, in the ear, and parenterally
B)Rectally, vaginally, topically, and in the eye and ear
C)Topically, in the eye and ear, and vaginally
D)Topically, in the eye and ear, rectally, and parenterally
Q4) Which of the following is not a component that determines the rate of release of biomaterials?
A)Water insoluble
B)pH dependent
C)pH independent
D)Toxicity Page 7
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Page 8
Chapter 6: Drug Information References
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Sample Questions
Q1) Goodman & Gilman's The Pharmacological Basis of Therapeutics contains all but which of the following subjects?
A)Pharmacodynamics
B)Drug transport
C)Drug metabolism pharmacogenomics
D)Drug prices
Q2) Remington's Pharmaceutical Sciences: The Science and Practice of Pharmacy covers the entire scope of pharmacy,from the history of pharmacy and ____ to the specifics of industrial pharmacy and pharmacy practice.
A)Ethics
B)Values
C)Beliefs
D)Pharmacy technicians
Q3) Trissel's Handbook on Injectable Drugs is a well-known reference used for information on which kind of agents?
A)Narcotics
B)Parenterals
C)Secret
D)All of the above
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Page 9
Chapter 7: Prescription Processing
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Sample Questions
Q1) The physician needs to check the prescription for the correct drug name,strength,dosage form,and amount and then sign the script.
A)True
B)False
Q2) Automated dispensing system (ADS)
A)Slang word used to describe a medical prescription
B)A pharmacy in a hospital
C)List of drugs that are not normally stocked by the pharmacy
D)Electronically sent prescription from prescriber's computer or mobile device that is transmitted directly to the pharmacy
E)Means to write
F)Attached to a container with specific instructions or information pertaining to the medication
G)These pharmacies are not open to the public
H)Machine that holds a supply of various medications
I)Found as a symbol on the header of a prescription
J)Also known as an outpatient or retail pharmacy
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Chapter 8: Over The Counter Medications
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Sample Questions
Q1) Analgesic
A)Aspirin
B)Chemical that aids in the removal of mucous secretions from the respiratory system
C)Those medications that do not require a prescription but are monitored
D)Fiber used to treat constipation or to cause a feeling of fullness to decrease appetite
E)Drug that reduces swelling, redness, and pain and that promotes healing
F)Medications that do not require a prescription and may be purchased by customers at any retail outlet
G)A drug that relieves pain by reducing the perception of pain
H)A substance that slows or stops the growth of microorganisms on surfaces such as the skin
I)Route of administration
J)A drug that can decrease the coughing reflex
Q2) Nonsteroidal antiinflammatory drugs are also used as analgesics and antipyretics.
A)True
B)False
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Chapter 9: Complementary and Alternative Medicine
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Sample Questions
Q1) Products derived from the genus Tanacetum are used to treat all but which of the following?
A)Fever
B)Arthritis
C)Muscle cramps
D)Asthma
Q2) Which of these is an ancient Indian approach to medicine still practiced today?
A)Biofeedback
B)Ayurveda
C)Acupressure
D)All of the above
Q3) According to the World Health Organization,alternative medicine now is estimated to be used by more than ____ percent of the world's population.
A)60%
B)50%
C)70%
D)80%
Q4) Biofeedback uses electrical leads to provide a readout of data.
A)True
B)False
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Chapter 10: Hospital Pharmacy
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25 Flashcards
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Sample Questions
Q1) In narcotics,accurate counts are important.
A)True
B)False
Q2) Satellite pharmacy technician
A)Fills prescription orders as patients leave the hospital
B)Responsible for ordering all medications and supplies for the pharmacy
C)Responsible for preparing large-volume drips and parenteral nutrition
D)Similar to a small, isolated pharmacy
E)Prepares cytotoxic agents
Q3) Crash carts contain:
A)Sublingual medications
B)Oral suspensions
C)Creams
D)Injectables
Q4) An E-MAR contains drug,dose,and time administered.
A)True
B)False
Q5) Stat trays vary depending on the patient's size.
A)True
B)False
13
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Chapter 11: Repackaging and Compounding
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Sample Questions
Q1) Bubble pack
A)The act of mixing, reconstituting, and packaging a drug
B)Base solution that is a mixture of alcohol and water
C)Markings on a measuring device
D)Part or portion of a medicine and/or ingredient that has the same volume or weight
E)A small particle
F)Bind together
G)Holds a single-dose tablet or capsule
H)Sealed with a foil card backboard
I)A hydrophilic base
J)An agent that contains small particles (1-1000 nm) that do not precipitate under the influence of gravity but remain distributed throughout either a suspension or an emulsion
Q2) Weights should always be placed on which side of the balance?
A)Left
B)Front
C)Right
D)Back
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Chapter 12: Aseptic Technique
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Sample Questions
Q1) If you touch a needle with alcohol,do not be concerned; alcohol is sterile and will not harm or contaminate the needle.
A)True
B)False
Q2) Gauge
A)Injection of a medication into the veins located on the periphery of the body system instead of a central vein or artery
B)Air originating from the back of the hood
C)Air originating from the roof of the hood moves downward
D)Preparations prepared in a sterile environment using nonsterile ingredients or devices that must be sterilized before administration
E)Medication that bypasses the digestive tract
F)Procedures used to eliminate the possibility of a drug becoming contaminated
G)To add a diluent such as saline or sterile water to a powder
H)A contained and controlled environment within the pharmacy
I)The size of the needle opening
J)To separate from solution or suspension
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15
Chapter 13: Pharmacy Stock and Billing
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Sample Questions
Q1) HMO stands for Homeopathic Medicinal Organization.
A)True
B)False
Q2) Following Health Insurance Portability and Accountability Act (HIPAA)regulations in ____,the pharmacy does not have access to information regarding reason for insurance rejection and is disclosed only a termination date.
A)2001
B)2005
C)2003
D)2007
Q3) Third-party billing refers to the portion of payment the customer pays.
A)True
B)False
Q4) Individuals must be 65 years or older,be younger than 65 with long-term disabilities,or suffer from end-stage renal disease in order to receive coverage from Medicare government-managed insurance.
A)True
B)False
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Page 16
Chapter 14: Medication Safety and Error Prevention
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32 Flashcards
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Sample Questions
Q1) All errors can be avoided through proper education and training.
A)True
B)False
Q2) A diabetic patient is ordered cefazolin in D W IV q8h.What possible problem may exist with this order?
A)A diabetic patient cannot be given cefazolin because of a possible drug interaction.
B)Cefazolin can only be given SubQ.
C)The dose should only be given q12h.
D)D W may be the wrong solution because the patient has diabetes.
Q3) Independent organization that strives to ensure the quality,safety,and benefit of medicine and dietary supplements by setting standards and certification processes
A)PTCB
B)ISMP
C)NCC MERP
D)ASHP
E)IHI
F)USP
G)PTEC
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Chapter 15: Endocrine System
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Sample Questions
Q1) Autoimmune disease
A)A condition that causes an increase in the level of adrenocorticotropic hormone
B)A condition that results in a decrease in corticoid levels
C)A condition in which a long-acting thyroid stimulator protein is constantly produced
D)A condition associated with a decrease in bone density
E)A condition in which a person's tissues are attacked by his or her own immune system
F)A condition associated with a decrease in overall thyroid function
G)A condition that results in softening and weakening of bones
H)A condition in which the thyroid is enlarged because of a lack of iodine
I)A condition in which development of the brain and body is inhibited
J)A condition associated with low concentrations of calcium in the blood
Q2) Hypocalcemia occurs when there is a low concentration of calcium in the blood.
A)True
B)False
Q3) The two primary hormones secreted by the ovaries are estrogen and progesterone.
A)True
B)False
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Page 18
Chapter 16: Nervous System
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Sample Questions
Q1) Which of the following is not a main function of the nervous system (NS)?
A)Relaying impulses to and from the central nervous system
B)Coordination of nervous system activities
C)Detection of body changes
D)Transportation of nutrients
Q2) The direction of neuronal impulse from the body toward the central nervous system is referred to as autonomic.
A)True
B)False
Q3) The nervous system is composed of:
A)Connective tissues
B)Sensory neurons
C)Epithelial cells
D)Macrophages
Q4) Which of the following is one of the primary neurotransmitters?
A)Caffeine
B)Norepinephrine
C)Phospholipids
D)Monoamine oxidases
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Chapter 17: Psychopharmacology
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Sample Questions
Q1) The term phobia comes from the Greek language and means panic attack.
A)True
B)False
Q2) Sonata
A)Antianxiety
B)Antipsychotics
C)Hypnotics
D)Antidepressant
E)ADD/ADHD medications
Q3) Patients with posttraumatic stress disorder have experienced:
A)A terrifying event
B)Trouble being in social situations
C)Panic attacks over most problems
D)None of the above
Q4) Risperdal
A)Antianxiety
B)Antipsychotics
C)Hypnotics
D)Antidepressant
E)ADD/ADHD medications
Page 20
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Chapter 18: Respiratory System
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Sample Questions
Q1) Sudafed
A)Decongestants
B)Antihistamines
C)Bronchodilators
D)Antitussives
E)Corticosteroids
F)Expectorant
Q2) Rhinovirus can cause a cold.
A)True
B)False
Q3) Isuprel
A)Decongestants
B)Antihistamines
C)Bronchodilators
D)Antitussives
E)Corticosteroids
F)Expectorant
Q4) Nasal decongestants cause an increase in the production of mucus.
A)True
B)False
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Chapter 19: Visual and Auditory Systems
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Sample Questions
Q1) Which of the following abbreviations means right ear?
A)AU
B)OD
C)AS
D)AD
Q2) Optometrists are trained to perform eye examinations and may prescribe certain medications for the eye.
A)True
B)False
Q3) Keeping eye solutions sterile is imperative because foreign objects instilled into the eyes can cause damage or infection.
A)True
B)False
Q4) Earwax provides a barrier from infection and acts as an antibacterial agent.
A)True
B)False
Q5) Ophthalmic preparations are sterile and can be used in the ear.
A)True
B)False
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Chapter 20: Integumentary System
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Sample Questions
Q1) Another name for hives is urticaria.
A)True
B)False
Q2) Enbrel
A)Antibacterial
B)Antifungal
C)Antivirals
D)Biologics
Q3) Which of the following is not a common skin condition usually treated at home?
A)Acne
B)Sunburns
C)Psoriasis
D)Hives
Q4) Your skin is the only part of your body that needs protection from the sun's rays.
A)True
B)False
Q5) New cells are produced in the basal layer.
A)True
B)False
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Chapter 21: Gastrointestinal System
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Sample Questions
Q1) Diarrhea can be fatal.
A)True
B)False
Q2) Mylicon
A)Nausea and vomiting
B)Constipation
C)Antiflatulent
D)Laxative
Q3) Antivert
A)Nausea and vomiting
B)Constipation
C)Antiflatulent
D)Laxative
Q4) FiberCon
A)Nausea and vomiting
B)Constipation
C)Antiflatulent
D)Laxative
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Page 24
Chapter 22: Urinary System
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Sample Questions
Q1) Which of the following is not a proper treatment for a urinary tract infection?
A)Septra to help kill the bacterial infection
B)Fluconazole to kill the fungal infection
C)Tetracycline to decrease the infection caused by Chlamydia
D)Zyloprim to clear up the gonorrheal infection
Q2) Renal fascia
A)Kidney stones
B)The loss of control over excretion of urine of feces
C)The loss of bladder control at night
D)The membranous tissue that surrounds and supports the kidneys.
E)Urination
Q3) The kidneys are needed for the synthesis of the following hormones except:
A)Renin
B)Erythropoietin
C)Vitamin D
D)Vitamin K
Q4) Edema is the retention of excess fluids usually occurring in the tissue closest to the kidneys.
A)True
B)False
25
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Chapter 23: Cardiovascular System
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Sample Questions
Q1) A myocardial infarction is also known as:
A)High blood pressure
B)An elevated heart rate
C)Gas caught in the heart chambers
D)A heart attack
Q2) Lasix
A)Antihyperlidemic
B)HMG-CoA reductase inhibitors (statins)
C)Calcium channel blocker
D)Antihypertensives
E)Anticoagulants
F)Diuretics
G)Antiplatelet
Q3) Congestive heart failure is when the heart is unable to meet the demands of the body.
A)True
B)False
Q4) Hypertension is commonly called high blood pressure.
A)True
B)False
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Chapter 24: Reproductive System
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Q1) Testosterone's main function is to increase the size of muscles.
A)True
B)False
Q2) The reproductive system is an independent system.
A)True
B)False
Q3) Synarel
A)Erectile dysfunction
B)Infertility medications
C)Long-acting contraceptives
D)STD medications
E)Endometriosis
Q4) Flagyl
A)Erectile dysfunction
B)Infertility medications
C)Long-acting contraceptives
D)STD medications
E)Endometriosis
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Page 27
Chapter 25: Antiinfectives
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Sample Questions
Q1) The medication Tamiflu is not an antiviral.
A)True
B)False
Q2) To stop or hold back; a means of being preemptive
A)Antibiotic
B)Symbiotic
C)Parasite
D)PRSP
E)Normal flora
F)Bacteria
G)Inhibit
H)Pneumonia
I)ESBLs
J)VRE
Q3) Antiparasitic agents work by all of the methods listed except:
A)Killing the parasite
B)Killing the host
C)Ridding the body of the live parasite
D)Paralyzing the parasites and then purging them from the body
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Chapter 26: Antiinflammatories and Antihistamines
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Q1) Patients will quantify pain by:
A)Taking a urine analysis
B)Comparing their pain to various smiley faces
C)Rating it on a numeric scale
D)None of the above
Q2) The adrenal cortex produces corticosteroids.
A)True
B)False
Q3) The most common condition that is self-medicated is inflammation,followed by the common cold.
A)True
B)False
Q4) Corticosteroids cause mild side effects.
A)True
B)False
Q5) Pain can be either short-lived or chronic.
A)True
B)False
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Chapter 27: Vitamins and Minerals
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Q1) Deficiency can cause rickets in children
A)Vitamin A
B)Vitamin D
C)Vitamin E
Q2) Patients do not need to check with their pharmacist or physician before taking vitamins or minerals.
A)True
B)False
Q3) Daily reference values on packages are only required to have mineral values.
A)True
B)False
Q4) Hemoglobin is:
A)A fat-soluble vitamin
B)A mineral
C)An iron-containing pigment
D)A free radical
Q5) Vitamins and supplements are regulated by the FDA.
A)True
B)False
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Chapter 28: Vaccines
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Q1) When a live vaccine is weakened it is considered attenuated.
A)True
B)False
Q2) Swine flu
A)Inactivated viral vaccines
B)Vaccines against bacterial illness
C)Systemic immunosuppressive agents
D)Biological response modifiers
Q3) Meningococcal
A)Inactivated viral vaccines
B)Vaccines against bacterial illness
C)Systemic immunosuppressive agents
D)Biological response modifiers
Q4) Who should not receive a live vaccine?
A)A healthy toddler
B)A senior citizen
C)A person with rheumatoid arthritis
D)A person with allergies
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Chapter 29: Oncology Agents
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Q1) Carcinogen
A)An unexpected change in the molecular structure within the DNA, causing a permanent change in cells
B)An invasive and destructive pattern of rapid, abnormal cell growth; often fatal
C)An agent used to prevent the development, proliferation, or growth of neoplastic cells; a medication used in treatment of abnormal cells
D)A single dose of drug
E)A tumor or growth that is not life-threatening
F)A substance or chemical that can increase the risk of developing cancer
G)The treatment of a disease with toxic chemical substances to slow the disease process or to kill cells
H)A procedure in which a piece of tissue is removed from a patient for examination and diagnosis; the tissue is a sample of the whole
I)The movement or spread of cancerous cells through the body to organs in distant areas
J)A term used to describe a malignant disorder of lymphoid tissue
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Chapter 30: Microbiology
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Sample Questions
Q1) What is the most common way to identify viruses?
A)Reaction with antibodies
B)Replication methods
C)Shape and size
D)All of the above
Q2) Robert Hooke is considered the Father of Microbiology.
A)True
B)False
Q3) Scientists have classified organisms into 10 different groups.
A)True
B)False
Q4) Viruses are not included in the five kingdoms.
A)True
B)False
Q5) How can viruses be stopped from replicating and spreading?
A)Inhibit the ability of the virus to attach to the host cell.
B)Inhibit replication by suppressing synthesis of viral DNA/RNA.
C)Inhibit the ability of the virus to assemble itself properly.
D)All of the above are true.
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Chapter 31: Chemistry
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Q1) Most atoms have an equal number of positively and negatively charged ions.
A)True
B)False
Q2) Which important chemical is responsible for supplying energy to the human body?
A)Chloride
B)Magnesium
C)Adenosine triphosphate
D)Zinc
Q3) Used to measure carbon
A)Micro
B)Mole
C)Amino acids
D)Catabolism
E)Ion
F)Covalent bond
G)Metabolism
H)Ionic bond
Q4) Amino acids are proteins that can regulate the speed of reactions.
A)True
B)False
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