CPhT CPhT Insurance and Billing 2

Question 1

What does 'COB' stand for in pharmacy billing?

Accepted Answer

Coordination of Benefits

Answer

COB (Coordination of Benefits) is the process of determining which insurance plan pays first when a patient has multiple insurance plans.

Question 2

What is a rejected claim in pharmacy billing?

Accepted Answer

An insurance claim that was not paid due to errors or eligibility issues

Answer

A rejected claim occurs when an insurance company does not process a prescription claim, often due to eligibility issues, incorrect information, or coverage limitations.

Question 3

What is the difference between a deductible and a copay?

Accepted Answer

A deductible is a set amount paid before insurance kicks in; a copay is a fixed per-prescription fee

Answer

A deductible is the annual amount a patient must pay before insurance begins covering costs, while a copay is a fixed fee paid for each prescription.

Question 4

What is a step therapy requirement?

Accepted Answer

A requirement to try lower-cost medications before a more expensive one is covered

Answer

Step therapy requires patients to try and fail on a preferred (usually cheaper) medication before insurance will cover a more expensive alternative.

Question 5

What does 'NPI' stand for in pharmacy billing?

Accepted Answer

National Provider Identifier

Answer

NPI (National Provider Identifier) is a unique 10-digit identification number required for all healthcare providers, including pharmacies, for billing purposes.

(CPhT) Certified Pharmacy Technician Practice Test

(CPhT) Certified Pharmacy Technician Practice Test

CPhT CPhT Insurance and Billing 2