Medical Insurance for Pharmacy Technicians
Janet McGregor Liles,
Arkansas State University
Cynthia Newby,
Chestnut Hill Enterprises
ISBN: 0073374164
Copyright year: 2010 Table of Contents
Chapter 1: From Prescription to Payment: Becoming a Pharmacy Technician Insurance Specialist
The Importance of Pharmacy Benefits
Medical Insurance Basics
The Pharmacy Practice Billing Cycle
Procedures, Communication, and Information Technology in the Pharmacy Billing Cycle
Effects of Pharmacy Claim Errors
Chapter 2: Medicolegal Issues and the Pharmacy
Health Care Regulation
Pharmacy Records
HIPAA Privacy Rule
HIPAA Security Rule
HIPAA Electronic Health Care Transactions and Code Sets
Other Legislation Affecting Pharmacy
Fraud and Abuse Regulations
Pharmacy Question and Answers
Chapter 3: Private Insurance Payers and Plans
Private Insurance
Types of Health Plans
Pharmacy Plan Benefits
Pharmacy Benefit Management Techniques
Calculating Charges
Chapter 4: Medicare
Medicare Overview
Medicare Part B Plans
Who Pays First?
Medicare Part D
Chapter 5: Medicaid, TRICARE, CHAMPVA, Workers’ Compensation, and Discount Card Programs
Medicaid
TRICARE and CHAMPVA
Workers’ Compensation
Discount Card Programs
Chapter 6: Claim Preparation and Transmission
Pricing Prescriptions
Creating Claims
Transmitting Claims
Coordination of Benefits
Chapter 7: Processing Claims and Appealing Decisions
Payer Adjudication of Claims
Collecting Patient Point-Of-Sale Payment
Pharmacy Processing of Payer Claim Payment
Balancing Transactions
Appealing and Resubmitting Claims
Insurer/PBM audits
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2010