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PTCB - Pharmacy Billing and Reimbursement QUESTIONS AND ANSWERS RATED A+ 2024/2025
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PTCB - Pharmacy Billing and Reimbursement QUESTIONS AND ANSWERS RATED A+ 2024/2025
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PTCB - Pharmacy Billing andReimbursement
Medicare gain (medicare part C) - ANSallows individuals in Medicare Part A and B to gain
insurance thru a Health Maintenance Organization or Preferred Provider Organization that gives
additional services at a better fee.
Medicare part A - ANSa federally funded fitness care program that pays for a affected person's
inpatient hospital care, professional nursing care, hospice care, and domestic fitness care
medicare component B - ANSa federally funded health care application that provides a patient
with coverage for doctor visits, outpatient care, physical therapy, and occupational remedy.
Medicare element D - ANSa federally funded health care application that provides a patient with
coverage for pick out prescription medicinal drugs, scientific resources, insulin, and
vaccinations.
Medicaid - ANSa federal software based totally on profits as well as other situations. Eligibility is
determined on a month with the aid of month foundation. It generally covers medical doctors
visits, emergency care, clinic care, vaccinations, prescriptions, imaginative and prescient,
hearing, and preventative care for kids
common wholesale fee - ANSthe common rate that wholesalers sell a medicine
real acquisition price - ANSactual price a pharmacy paid for a medicinal drug
formulary - ANSa list of medicines accepted for use or reimbursement below a prescription plan.
Open formulary - ANSa style of several medicines in each healing classification
closed formulary - ANSa very confined range of medications available in each healing category,
and occasionally no medicines in certain classifications.
Restrained formulary - ANSa selective, constrained, partly closed formulary in which some
non-formulary medicines are to be had.
On line adjudication - ANSthe manner with the aid of which a pharmacy submits prescription
claims electronically to a third birthday celebration company while filling a prescription to make
sure accurate copayments and timely fee. It permits the pharmacy to verify a patient's eligibility
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