Pharmacy Billing and Reimbursement - PTCB Test Prep

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Pharmacy Billing and Reimbursement

Welcome to your Pharmacy Billing and Reimbursement

1. In insurance, which of these terms refers to the main cardholder?
2. Members are NOT required to select a PCP under which of these insurance systems?
3. Government provides or subsidizes which of the following kinds of insurance?
4. What term is used to describe the amount that must be paid each year before the healthcare benefits of an insurance plan commence?
5. Which of these insurance code associations is false?
6. TRICARE is a government plan that covers which of the following patients?
7. Which of the following statements about HIPAA is true?
8. When medicines are dispensed, which of the following is paid by the patient to the pharmacy?
9. Prescription drug plans fall under which of these Medicare plans?
10. CHAMPVA is a government program that is involved in providing healthcare to which of these?
11. To maintain insurance coverage, what term is used to describe the cost of that patient’s insurance plan?
12. Which of the following statements about Medicaid is true?
13. Which of the following is covered by Medigap?
14. Which of the following details is NOT required by insurance companies when processing a prescription claim?
15. Nursing home stays are covered under which Medicare plan?
16. With whom are FSAs – flexible spending accounts – associated?
17. What is the coverage under Medicare Plan A?
18. Which Medicare plan covers defined vaccines administered to the patient at pharmacies?
19. In which pharmacy book can you expect to find AWPs?
20. Which of these terms refers to the act of processing an insurance claim?
21. Prior authorization may be required in which of the following cases?
22. Patients with more than one kind of insurance coverage are obligated to follow which of these rules?
23. Which of these statements is false regarding Centers for Medicare and Medicaid Services (CMS)?
24. The biller identification number (BIN) is a _____________ number that is present on health insurance cards to specify an insurance plan from a defined carrier.
25. For prescription insurance plans, how frequently are deductibles reset?
26. In which of these cases may an insurance company reject a patient claim?
27. The spouse of the insurance card holder is assigned which of these values?
28. Durable medical equipment (DME) – such as blood glucose monitors – are covered under which of the following Medicare plans?
29. Under Medicare Part C, private insurance companies can offer which of these other Part benefits?
30. Which of the following is required for members who are part of an HMO?

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