PTCB exam 2020 Questions and Answers Rated A (CPT billing codes 99605, 99606, and 99607) Correct Answer-Medication Therapy Management (MTM) (CPT billing codes 99211-99215) Correct Answer-Incident-t... o (CPT codes 99496 and 99495) Correct Answer-Transitional care management (TCM) (CPT codes G0438 and G0439) Correct Answer-CMS annual wellness visit (AWV) (CPT codes 99490) Correct Answer-Incident-to physician: Chronic care management (CPT codes 99487 and 99489)I Correct Answer-ncident-to physician: Complex chronic care management (CPT codes G0108 and G0109) Correct Answer-Diabetes self-management training (CPT codes 98960, 98961, and 98962) Correct Answer-Diabetes education(APC code 5012 with HCPCS code G0463) Correct Answer-Office visit in a hospital-based clinic (Hospital outpatient) (CPT codes 99211-99215) Correct Answer-The majority of options for pharmacist revenue generation are through the Evaluation and Management (E&M) Prior Authorization Correct Answer-the need to obtain permission from the insurance company before seeking certain types of services There are several kinds of medications that may require prior authorization: Correct Answer-1- A brand name medication that is available as a generic 2- An expensive medication 3- A medication used for cosmetic reasons (such as those for hair growth and wrinkle treatment) 4- A medication prescribed at higher doses than normal 5- A medication that treats non-life threatening conditions 6- A medication not usually covered by the insurance company, but deemed medically necessary by the physician Steps for Prior Authorization: Correct Answer-Step 1: The pharmacy contacts the physician who prescribed the medication to see if he or she obtained prior authorization from the insurance company when the drug was prescribed.Step 2: If not, the physician will contact the insurance company and submit a formal authorization request. Step 3: The insurance provider may have the patient complete and sign forms. Step 4: The insurance company will alert the pharmacy once they have approved the prescription or denied the request. PHARMACY CLAIM REJECTIONS AND FIXES Correct Answer-1- No PCN (Processor Control Number) on the claim. To fix this error, you must find the PCN from the patient's insurance card or insurance company and then edit the claim before resubmitting. You may need to contact the insurance company to get more information on the problem. 2- No Group Number on the claim. To fix the problem, you must find the patient's group number on the insurance card, fix the error, and resubmit the claim. 3- No NPI (National Provider Identifier) or invalid NPI on the claim. The pharmacist must have a contract with the payer. Once the contract is negotiated, the payer will provide an NPI number. This number is then inputted into the pharmacy software and included on all claims. 4-No Cardholder ID Number or invalid Cardholder ID number on the claim. To fix this, you must find the correct Cardholder ID number and resubmit the claim. 5- Plan Limitations Exceeded. If the claim submitted needs prior approval before coverage because of the medication expense, it may be rejected. Additionally, if the medication was already filled in the last 30 days or the quantity dispensed is over the allowed amount for the day supply, the claim may be rejected. To fix these issues, you will need to contact the insurance company to obtain an override or approval on the cost before resubmitting the claim. 6-Waiting Too Long to File the Claim. Most insurance companies allow 60 to 90 days from time of service to file a claim. When claims are filed past that time, the claim may be rejected. 7-Incorrect Patient Information. Any error in patient information will trigger a claim rejection. Commonerrors include incorrect name, days supply, provider, date of birth, etc. 8-Coverage has expired. If the patient does not pay premiums or no longer works at employer-provided insurance, the patient's coverage may not be current. 10-Coverage limits have been exceeded. The insurance plan may have a limit on the amount of coverage they provide for each patient annually or for a lifetime. The claim may be rejected if the coverage limits have been exceeded. 11-Refills. In some cases, the patient may be trying to get a prescription refilled when it either is not refillable or within too short of a time frame. The insurance payer may reject this claim. 12-Invalid Amount. The prescription may be written for an invalid amount of the medication. Most insurance companies cover only a 30-day supply of medication. Mail-order prescriptions may cover a 90- day supply. The amount depends on the actual drug. Coordination of Benefits (COB) Correct Answer-is the process in which two or more health insurers cover the same person(s) but limit the total benefit payable for a claim to an amount not exceeding the total cost of the claim. Coordination of Benefits applies to retail pharmacy claims, member-submitted paper claims, and mail-order claims. Medicare, Medicaid, and private insurance companies have rules for determining who pays for the prescription in the case where more than one insurance payer covers the individual. The Birthday Rule for Dependents of Parents who Live Together: Correct Answer-This rule determines whether a plan is primary or secondary for a dependent child who is covered by both parents.If both parents have the same birthday, then the plan that has been in effect the longest pays as primary.Birthday Rule for Dependents whose Parents are Divorced or Separated or are Not Living Together (Whether or Not They Have Ever Been Married: Correct Answer-If the court decree states that one of the parents is responsible for the child's healthcare expenses/coverage and the plan covering that parent as actual knowledge of those terms, that plan is primary. If the responsible parent has no coverage for the child's healthcare expenses, but that parent's spouse does, that parent's spouse's plan is the primary plan. If a court decree states that both parents are responsible for the child's healthcare expenses/coverage, the Birthday Rule determines the order of benefits. If the court decree states that the parents have joint custody without specifying that one parent has healthcare coverage responsibility, the Birthday Rule determines the ordre of benefits. If there is no court decree allocating healthcare coverage responsibility for the child, the order of benefits for the child is as follows: a. the plan covering the custodial parent; b. the plan covering the custodial parent's spouse; c. the plan covering non-custodial parent; and then, d. the plan covering the noncustodial parent's spouse hood suould be operated ? Correct Answer-24 hours in hospitals pharmacy and at least 30 min prior to use in comunity pharmacy. what reasonable working distance from the Hood? Correct Answer-work should be at least 6 inches into the hood.sterile instruments should be held under ? Correct Answer-Class 100 (ISO 5) The federal food and drug act (1906) Correct Answer-prohibited instersate commerce and adulterated and misbranded drugs. Fedral Food Drugs and Cosmetics Act ( FDCA1938) Correct Answer-Established the FDA (stated the drugs cannot brought on the market untill proved to be safe), clarified the definition of misbranding and adulteration. Durham-Humphrey Amendment (1951) Correct Answer-It requires the drug prove to be safe and print instructions clearly on the manufacture label. Created new legend drug what's known as prescription drug. And created warning (Caution Federal law prohibits dispensing without prescription) Currently the requirement has been changed in shorter warning (Rx only). The Kefauver-Harris Amendment (1962) Correct Answer-This law requres for the first time a proof of the effectiveness of the drug as well as its safety. The food and administration modernization act (1997) Correct Answer-This act simplifies many FSA regulations and procedures. It allows greater ease and speed with the FDA can approve a new drug and granted access to investigational medication. It's also abbreviated the warning to Rx OnlyThe Drug Addiction Treatment Act (2000) Correct Answer-This act permitted physician who completed a training course and who registers with the DEA to prescribe approved C-III, C-IV, C-V medication. The Medicaire Modernization Act (2003) Correct Answer-Allow medicaire benificiaries to enroll in medicaire advantage, or medicaire part D (coverage for prescription drug). USP Chapter<797> Correct Answer-2004 & 2007, it outlines procedure and practices required for safe and proper compounding for sterile preparations USP Chapter <795> Correct Answer-Outlines the procedure of proper compounding of non-sterile preparations. The Combat Methamphetamine Epidemic Act (2005) (CMEA) Correct Answer-Regulates retail OTC sales of ephedrine, pseudoephedrine, phenylpropanolamine product, (3.6 grams per purchase per day), (for mail order 7.5g for 30 days), (for non-mail order 9g during 30 days period). (required all non-liquid form including gel caps to be in 2-unit blister pack) Medicaid Temper-Resistant Prescription Pad Law (2008) Correct Answer-Require the physician to write prescriptions on temper-resistant pads.Affordable Care Act (2010) Correct Answer-Ensures American access to insurance coverage. Americans may choose insurance through an open market exchange. The Harrison Narcotic Act (1916) Correct Answer-To control illegal trafficking of narcotics. This law employs taxation on legally sold narcotics to restrict trafficking. The Drug Abuse Control Amendment (DACA) (1965) Correct Answer-Expands Harrison Act to include barbiturates and stimulant drugs The Bureau of Narcotics and Dangerous Drugs (1968) Correct Answer-The Harrison Act and DACA were combined under newly formed Bureau of Narcotics and Dangerous Drugs. in 1973, the Bureau was renamed to the DEA (Drug Enforcement Administration). The Comprehension Drug Abuse Prevention and Control Act (1970) Correct Answer-Known as Controlled Substances Act (CSA). Replaced the Harrison and DACA and established the concept of the DEA number originated with the CSA. The Poison Prevention Packaging Act (PPPA) (1970) Correct Answer-Requires locking cap on all prescriptions dispensed from pharmacy with only 3 exceptions. 1) when patient asks for non-safety lid 2) when prescriber asks for non-safety lid 3) when the drug dispensed is an exempted drug (sublingual nitroglycerin).Also required all the prescriptions bottles to be child proof. The OBRA Law (1990) (Omnibus Budget Reconcildation Act) Correct Answer-1) Retrospective Drug Utilization Review (DUR) 2) Prospective Drug Utilization Review 3) Mandates councilling to medicaid patient (many states extend councelling to all patients) JCAHO (Joint Commission on Accreditation of Healthcare Organizations) Correct Answer-Nongovernment organization conduct voluntary certification and inspection on 20,000+ healthcare organizations including Hospital, Nursing Homes, long term care facilites, Ambulatory care providors, and clinical laboratories Patient Package Insert (Monographs) Correct Answer-1) Regulated by FDA 2) PPI (Monograph) must include A) indication B) Contradiction C) Warning D) Precaution E) Dose and Route of administrationOccupational Safety and Health Administration (OSHA) (1970) Correct Answer-1) Ensures safe workplace for employee by reducing hazards in workplace 2) Ensures job safety standard and requires reporting of any job related injuries or illness 3) Requires Material Safety data sheet (MSDS) for any hazardous material Health Insurance Portability and Accountability Act (HIPAA) (1996) Correct Answer-1) Protect health insurance coverage for workers and their family when they change job or lose their job. (Purpose of this act to protect personal health information of patient) 2) Administration simplification - established electonic transaction and code set standards and required health information privacy ---HIPPA Regulation--- A) Must Disclose protected health information (PHI) in two circumstances: First - when patient requests access to their own record. Second - when HHS office for civil rights requests for information B) May disclose PHI in instance which concerns patient treatment payment operation C) Court Order D) Criminal Investigation Evidence MedWatch (1993) Correct Answer-This is the FDA reporting service for adverse effects that occur from use of approved drugs. When we report any adverse event of drugs, we have to file form FDA 3500 Drug Recalls Correct Answer-Class 1: Serious adverse health consequences or death Class 2: Health consequences are reversibleClass 3: Not likely to cause adverse health consequences (physically adulterated drug or mislabelling drugs) The New Drug Application Process (NDA Process) Correct Answer-Phase I - Trial involves small # of volunteers to determine maximum tolerated dose of applicant drug (toxicity) Phase II - Primarily concerned with (effectiveness) Phase III - Last trial before NDA submitted to FDA. "Double Blind" method with thousands of individuals. Phase IV - takes place after NDA submits to FDA. Allows manufactures to produce drugs National Drug Code (NDC) Correct Answer-Each drug produced by a manufacturer is identified with a specific NDC number. The NDC number is composed of three sets of numbers, which identifies the manufacturer, drug, and pack size. The first 5 numbers represent the manufacturer. the second 4 numbers represent the drug. The last/third 2 numbers represent the packaging size. 00000-0000-00 DEA number formula Correct Answer-(1st + 3rd + 5th) + 2 (2nd + 4th + 6th) = last digit is last digit of DEA #. Usually the first letter is A or B for physician, provider F or P for manufacturer M for mid-level provider The 2nd letter represents the last name of the providerAG2705208 DEA Forms Correct Answer-222 - to order CII's 224 - to register with the DEA - check box to get 222 forms with registration 106 - to report theft or loss to the DEA 41 - to report drugs surrendered for disposal 104 - pharmacist surrender his/her license Controlled Substances Act of 1970 Correct Answer-classifies controlled substances according to their abuse potentials. Schedule II = Prescription can be handwritten or computer generated but must be signed in ink by physician (no allowable refill) Schedule III-V = Prescription can be handwritten or computer generated must be signed by physician in ink the office may telephone or fax prescription. Paitent may receive up to 5 refills within 6 months. Emergency Schedule II Prescription = An oral prescription can be issued under the following conditions:A) Pharmacist must make a good faith attempt to identify the physician B) Limited to quantity to treat patient during period of emergency only. C) Pharmacist must reduce order to writing D) Physician must write prescription for this emergency quantity (pharmacy must receive it within 72 hours of oral order) What color of the pharmaceutical waste container? Correct Answer-Black What color of the chemotherapy waste container? Correct Answer-Yellow What color of the non hazardous pharmaceutical waste container? Correct Answer-Green What color of sharp objects container Correct Answer-Red convert pint to mL Correct Answer-1 pint =473.17 mL convert pint to oz Correct Answer-1 pint -16 OZ oz to grams Correct Answer-1 oz = 28.4 gqt to mL Correct Answer-1 qt = 946 mL qt to pt Correct Answer-1 qt = 2 pt Calculating active ingredient Correct Answer-1w/v1000 = (g of active ingredient/mL of active ingredient) Code 1 for insurance billing Correct Answer-Insured Code 2 for insurance billing Correct Answer-Spouse Code 3 for insurance billing Correct Answer-Dependent rejection code 19 Correct Answer-Day supplied missing or not valid Rejection code 11 Correct Answer-Relationship code invalid or missing Rejection code 9 Correct Answer-When date of birth invalid or missingRejection code 04 Correct Answer-Processor Control Number (PCN) Rejection code 06 Correct Answer-Group number is missing or invalid Rejection code 40 Correct Answer-Pharmacy not contracted with this plan Rejection code 01 Correct Answer-BIN number is missing or invalid Rejection code 05 Correct Answer-invalid or missing service provider number Capsules sizes Correct Answer-A size 0 =500 mg size 1 = 400 mg size 2 = 300 mg size 3 200 mg What type of balance must a pharmacy have? Correct Answer-Class A according to USP <795> what the air velocity of laminar floww hood Correct Answer-90 linear feet/min (±20) , acc [Show More]
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