DME
What does DME stand for?
What is Durable Medical Equipment
What do we call the insurance company?
What is the carrier or insurer
If a patient has not met their deductible, how much will they pay for a $200 prescription?
What is $200
What agency regulates medication guides and labeling requirements?
What is: FDA
DUR stands for this type of review.
What is Drug Utilization Review
How are DME claims submitted to Medicare Part B?
What are paper claims
What does a deductible mean?
What is : The amount a patient must pay before insurance starts covering costs.
After meeting a $300 deductible, how much does a patient pay for a $150 prescription with 75% coverage?
What is $37.50?
Which NSAIDs require food to reduce GI side effects?
What are : Celecoxib, naproxen, ibuprofen
DUR alerts can be classified in three severity levels. Name one.
What is mild, moderate, or severe
What does a pharmacy need to bill DME to Medicare Part B?
What is DMEPOS accreditation or exemption
What is a claim?
What is: A request for reimbursement to the insurance provider.
If a $75 medication has a $25 copay, how much does the insurance cover?
What is $50
Why must nitrofurantoin be taken with food?
What is : It won’t be absorbed and will be ineffective if taken on an empty stomach
A DUR alert for sulfa allergy appears. What’s the pharmacist’s first step?
What is check the patient’s allergy history/profile
Why does reimbursement take longer for DME claims?
What is : Because they are not processed in real time
What is the term for how long a prescription is meant to last?
What is days’ supply
If a prescription costs $200 and insurance pays 75%, how much does the patient owe?
What is $50
What is a reason the FDA might require a medication guide?
What is : Risk of serious side effects or incorrect use.
This is used by pharmacists to record how they handled a DUR alert.
What are DUR codes