# CTE Resource Center - Verso - Pharmacy Technician II Task 892628053

CTE Resource Center - Verso

Virginia’s CTE Resource Center

Perform billing and accounting functions for pharmacy functions and goods.

Definition

Performance should include functions such as
  • auditing
  • tiers
  • dispense as written (DAW) code
  • days' supply
  • dose
  • deductable/donut hole/gap
  • coupons
  • personal charge accounts
  • third-party rejections
  • third-party reconciliations
  • census maintenance
  • prior authorization
  • state managed insurance programs
  • co-pay, co-insurance, dual co-pay (e.g., generic vs. brand)
  • maximum allowable cost (MAC)
  • usual, customary, and reasonable (UCR) price
  • out-of-pocket costs
  • formulary
  • prescription drug benefits card: patient ID number, group number, and co-pay amount
  • referrals
  • primary care physician
  • search of insurance database for coverage
  • state, federal, and third party insurance payer
  • communication of co-pay information to patient
  • electronic payment processing
  • online adjudication
  • Medication Therapy Management (MTM) billing process
  • Pharmacy Benefits Manager (PBM)
  • generic and therapeutic substitution
  • limits: quantity-per-fill, number of refills, and time between refills
  • readily retrievable signature logs and prescriptions
  • Exclusive Provider Organization (EPO), Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Health Savings Account (HSA), Point of Service Plan (POS), and Patient Centered Medical Home (PCMH)
  • workers’ compensation, COBRA, disability insurance, and manufacturer sponsored patient assistance programs.

Process/Skill Questions

  • What are the steps in obtaining prior authorization? Why is each step important?
  • What is the role of a pharmacy technician in processing third-party payments and/or rejections?
  • What is the purpose of a financial audit?
  • What is the purpose of a third-party-payer audit?
  • How might financial audits apply to the pharmacy setting? Why are they important?
  • What are the different types of insurance plans or cards in use?
  • How do the HIPAA privacy and security regulations affect billing processes involving third party payers and vendors that process electronic payments (e.g., credit card companies, banks)?
  • How might billing proceed for a patient with more than one insurance plan?
  • What is the difference between primary and secondary insurance?

Related Standards of Learning

English

11.5

The student will read, interpret, analyze, and evaluate a variety of nonfiction texts including employment documents and technical writing.
  1. Apply information from texts to clarify understanding of concepts.
  2. Read and correctly interpret an application for employment, workplace documents, or an application for college admission.
  3. Analyze technical writing for clarity.
  4. Paraphrase and synthesize ideas within and between texts.
  5. Draw conclusions and make inferences on explicit and implied information using textual support.
  6. Analyze multiple texts addressing the same topic to determine how authors reach similar or different conclusions.
  7. Analyze false premises, claims, counterclaims, and other evidence in persuasive writing.
  8. Recognize and analyze use of ambiguity, contradiction, paradox, irony, sarcasm, overstatement, and understatement in text.
  9. Generate and respond logically to literal, inferential, evaluative, synthesizing, and critical thinking questions about the text(s).

11.8

The student will analyze, evaluate, synthesize, and organize information from a variety of credible resources to produce a research product.
  1. Critically evaluate quality, accuracy, and validity of information.
  2. Make sense of information gathered from diverse sources by identifying misconceptions, main and supporting ideas, conflicting information, point of view or bias.
  3. Synthesize relevant information from primary and secondary sources and present it in a logical sequence.
  4. Cite sources for both quoted and paraphrased ideas using a standard method of documentation, such as that of the Modern Language Association (MLA) or the American Psychological Association (APA).
  5. Define the meaning and consequences of plagiarism and follow ethical and legal guidelines for gathering and using information.
  6. Demonstrate ethical use of the Internet.

12.5

The student will read, interpret, analyze, and evaluate a variety of nonfiction texts.
  1. Use critical thinking to generate and respond logically to literal, inferential, and evaluative questions about the text(s).
  2. Identify and synthesize resources to make decisions, complete tasks, and solve specific problems.
  3. Analyze multiple texts addressing the same topic to determine how authors reach similar or different conclusions.
  4. Recognize and analyze use of ambiguity, contradiction, paradox, irony, overstatement, and understatement in text.
  5. Analyze false premises claims, counterclaims, and other evidence in persuasive writing.

12.8

The student will analyze, evaluate, synthesize, and organize information from a variety of credible resources to produce a research product.
  1. Frame, analyze, and synthesize information to solve problems, answer questions, and generate new knowledge.
  2. Analyze information gathered from diverse sources by identifying misconceptions, main and supporting ideas, conflicting information, point of view, or bias.
  3. Critically evaluate the accuracy, quality, and validity of the information.
  4. Cite sources for both quoted and paraphrased ideas using a standard method of documentation, such as that of the Modern Language Association (MLA) or the American Psychological Association (APA).
  5. Define the meaning and consequences of plagiarism and follow ethical and legal guidelines for gathering and using information.
  6. Demonstrate ethical use of the Internet.

Mathematics

COM.1

The student will design and apply computer programs to solve practical problems in mathematics arising from business and applications in mathematics.

Other Related Standards

Pharmacy Technician Certification Board (PTCB) Examination Required Knowledge

I. Assisting the Pharmacist in Serving Patients

 

 

I.1. Knowledge of federal, state, and/or practice site regulations, codes of ethics, and standards pertaining to the practice of pharmacy

 

I.2. Knowledge of pharmaceutical, medical, and legal developments which impact on the practice of pharmacy

 

I.5. Knowledge of generic and brand names of pharmaceuticals

 

I.6. Knowledge of therapeutic equivalence

 

I.13. Knowledge of strengths/dose, dosage forms, physical appearance, routes of administration, and duration of drug therapy

 

I.14. Knowledge of effects of patient’s age (for example, neonates, geriatrics) on drug and non-drug therapy

 

I.15. Knowledge of drug information sources including printed and electronic reference materials

 

I.20. Knowledge of practice site policies and procedures regarding prescriptions or medication orders

 

I.73. Knowledge of confidentiality requirements

 

I.74. Knowledge of cash handling procedures

 

I.75. Knowledge of reimbursement policies and plans