WHAT CATEGORY DO AGING REPORTS GROUP UNPAID BILLS?
TIME
100
HOW OFTEN ARE CARC AND RARC CODES ADJUSTED?
REGULARLY
100
CAN YOU DISPENSE A PRESCRIPTION WITH PENDING EDITS?
NOPE
100
DO PHARMACIES HAVE TO KEEP RECORDS OF ALL CLAIM SUBMISSIONS AND DENIALS UNTIL THE FINAL RESOLUTION IS REACHED?
YUP
100
ARE ALL CLAIMS RESUBMITTED TO THE PAYER ACCEPTED ON THE 2ND ATTEMPT?
NOPE
200
WHO OFFERS FREE SOFTWARE FOR REMITTANCE ADVICE?
MEDICARE
200
CAN A PHARMACY HIRE A COLLECTION AGENCY TO COLLECT OVERDUE BILLS?
YUPPERS
200
IF AN EDIT CANNOT BE RESOLVED, THE FULL COST OF THE PRESCRIPTION FALLS ON WHOM?
THE PATIENT
200
WHAT TERM IS USED WHEN OWED MONEY IS NO LONGER EXPECTED TO BE COLLECTED?
WRITE-OFF
200
WHAT ENTITY OR LAW IS THE ASC X12N 835 COMPLIANT TO?
HIPAA
300
WHAT AUDIT IS DONE ON-SITE, WITH A REPRESENTATIVE PRESENT?
FIELD-AUDIT
300
WHAT CAN A PHARMACY DO IF IT BELIEVES THAT THE PRESCRIBED MEDICATION IS SAFE FOR A PATIENT AFTER RECEIVING A SAFETY EDIT?
HAVE A PHARMACIST OVERRIDE THE EDIT AND DOCUMENT IT.
300
WHAT CAN A PHARMACY DO IF THEY THINK THE PAYER HAS MISTAKENLY REJECTED A VALID CLAIM?
RESUBMIT AND/OR APPEAL THE CLAIM
300
ACCOUNT RECONCILIATION IS ALSO KNOWN AS...
BALANCING THE ACCOUNT
300
AUTOMATIC,ELECTRONIC, MANUALLY, INTERNAL, EXTERNAL
ARE WHAT?
WAYS ACCOUNT RECONCILIATIONS ARE PERFORMED
400
WHAT DOES A HIGH DOLLAR EDIT PREVENT?
IT PREVENTS CLAIMS THAT EXCEED A DOLLAR AMOUNT FROM CONTINUING WITHOUT DATA OR OVERRIDES
400
WHEN DOES AN ADJUSTMENT OCCUR?
WHEN THE AMOUNT CHARGED ON THE CLAIM IS NOT EQUAL TO THE AMOUNT PAID
400
WHAT DO EDITS CHECK FOR?
ERRORS AND MISSING INFORMATION ON PRESCRIPTION CLAIMS
400
WHAT 2 ACTS MUST THE PHARMACY FOLLOW THE GUIDELINES OF TO COLLECT PAYMENTS?
FAIR DEBT COLLECTIONS PRACTICES ACT OF 1977
TELEPHONE CONSUMER PROTECTION ACT OF 1991
400
WHAT AUDIT IS DONE OFF-SITE, VIA COMPUTER OR MAIL
DESK-AUDIT
500
PR, CO, CR, PI, OA
WHAT ARE THESE?
CLAIM ADJUSTMENT GROUP CODES
500
DRUG-DRUG INTERACTION, AGE/GENDER CONTRAINDICATIONS, DAY SUPPLY/MAX QUANTITY, THERAPEUTIC DUPLICATION, TIME INTERVAL
ARE WHAT?
SAFETY EDITS
500
REPAYMENT OF ANY IMPROPERLY OBTAINED PAYMENTS
TERMINATION OF THE CONTRACT WITH THE PAYER
REFERRAL TO LAW ENFORCEMENT AGENCIES AND/OR STATE
AND FEDERAL AGENCIES
HAPPENS WHEN?
THE NEGATIVE FINDINGS OF AN AUDIT ARE NOT RESOLVED BY THE PHARMACY
500
WHAT ARE THE 3 TYPES OF ELECTRONIC REMITTANCE ADVICE TRANSACTIONS CODES?