Inventory Management & Billing Flashcards
7 cards from real PTCB practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Inventory Management & Billing flashcards as text
What does 'DAW' stand for on a prescription, and what does DAW 1 indicate?
Answer: Dispense As Written; the prescriber requires the brand-name drug
DAW (Dispense As Written) codes indicate substitution instructions; DAW 1 means the prescriber specifically requires the brand-name product.
Which government program provides prescription drug coverage primarily for individuals aged 65 and older?
Answer: Medicare Part D
Medicare Part D is the federal prescription drug benefit designed for Medicare beneficiaries, primarily those aged 65 and older.
What is a 'prior authorization' (PA) in pharmacy billing?
Answer: Insurance plan approval required before covering a specific medication
A prior authorization is approval from the insurance plan that must be obtained before the plan will cover certain high-cost or non-formulary medications.
What does 'adjudication' mean in the context of pharmacy billing?
Answer: The electronic process of submitting a claim to insurance and receiving payment determination
Adjudication is the real-time electronic process where the pharmacy submits a claim and the insurance plan returns a payment approval or rejection.
A patient has both primary and secondary insurance. What is 'coordination of benefits' (COB)?
Answer: The process of determining how two insurance plans share payment responsibility
COB rules determine which insurance plan pays first (primary) and how the secondary plan covers remaining costs to prevent overpayment.
What is the 'deductible' in a prescription drug insurance plan?
Answer: The amount the patient must pay out-of-pocket before insurance begins covering costs
A deductible is the amount a patient must pay out-of-pocket before the insurance plan starts contributing to prescription costs.
Which term describes the fixed dollar amount a patient pays for each prescription, regardless of the drug's total cost?
Answer: Copay
A copay (or copayment) is a fixed dollar amount (e.g., $10 or $40) the patient pays per prescription fill, independent of the medication's actual price.