Medical Insurance for Pharmacy Technicians / Edition 1

by Janet Liles, Cynthia Newby

Overview

Medical Insurance for Pharmacy Technicians provides a practical, focused overview of medical insurance and billing of prescriptions in the community pharmacy setting. Each chapter is structured to give students a hands-on, practical approach to understanding and working with prescription charges and the billing process. This text is precisely tailored for a brief introduction to the fundamental understanding of claim processing principles for pharmacy technicians.

Product Details

ISBN-13:	9780073374161
Publisher:	McGraw Hill LLC
Publication date:	02/19/2009
Edition description:	New Edition
Pages:	192
Sales rank:	686,494
Product dimensions:	8.40(w) x 10.70(h) x 0.40(d)

About the Author

Cynthia Newby, CPC, CPC-P, is a long-serving author who works closely with McGraw-Hill Education instructional development staff to develop excellent MIBC programs. Cynthia is a graduate of Hood College and a trustee of that institution as well as her local animal shelter and library.

Table of Contents

Chapter 1: From Prescription to Payment: Becoming a Pharmacy Technician Insurance SpecialistThe Importance of Pharmacy BenefitsMedical Insurance BasicsThe Pharmacy Practice Billing CycleProcedures, Communication, and Information Technology in the Pharmacy Billing CycleEffects of Pharmacy Claim ErrorsChapter 2: Medicolegal Issues and the PharmacyHealth Care Regulation Pharmacy RecordsHIPAA Privacy RuleHIPAA Security Rule HIPAA Electronic Health Care Transactions and Code SetsOther Legislation Affecting PharmacyFraud and Abuse RegulationsPharmacy Question and AnswersChapter 3: Private Insurance Payers and PlansPrivate InsuranceTypes of Health PlansPharmacy Plan Benefits Pharmacy Benefit Management TechniquesCalculating ChargesChapter 4: MedicareMedicare OverviewMedicare Part B PlansWho Pays First?Medicare Part DChapter 5: Medicaid, TRICARE, CHAMPVA, Workers’ Compensation, and Discount Card ProgramsMedicaidTRICARE and CHAMPVAWorkers’ CompensationDiscount Card ProgramsChapter 6: Claim Preparation and TransmissionPricing PrescriptionsCreating ClaimsTransmitting ClaimsCoordination of BenefitsChapter 7: Processing Claims and Appealing DecisionsPayer Adjudication of ClaimsCollecting Patient Point-Of-Sale PaymentPharmacy Processing of Payer Claim PaymentBalancing Transactions Appealing and Resubmitting Claims Insurer/PBM audits