Knowledge Check
Module 4: Payors & Risk
Answer all 3 questions to complete this module. You need 70% or higher to pass.
1
Which payor is described as IFH's "bread and butter" in California?
Medicare Part B
Commercial Insurance
Medi-Cal (Medicaid)
Medicare Part D
2
What is "white bagging" and why is it a risk?
When patients bring their own medications to the infusion center
When a payor forces the drug to come from their own specialty pharmacy, cutting IFH out of drug revenue
When medications are shipped in white packaging
A type of prior authorization denial
3
What is the key difference between medical benefit and pharmacy benefit coverage?
Medical benefit always has better reimbursement
Pharmacy benefit uses J-codes while medical uses NDC numbers
Medical benefit uses J-codes and covers drug + nursing + supplies; pharmacy benefit uses NDC numbers through a PBM
There is no practical difference for home infusion