PTCB - Pharmacy Billing and
Reimbursement Questions and
Answers | Latest Version | 2025/2026 |
Correct & Verified
What is the primary purpose of pharmacy billing?
✔✔ To ensure accurate payment for medications dispensed.
Which form is commonly used to submit pharmacy claims to insurance companies?
✔✔ CMS-1500 or electronic claim forms.
What does the acronym NPI stand for in pharmacy billing?
✔✔ National Provider Identifier.
Which code set is used to identify diagnoses for reimbursement?
✔✔ ICD (International Classification of Diseases) codes.
Which code set is used to identify procedures for billing purposes?
✔✔ CPT (Current Procedural Terminology) codes.
1
, What is the purpose of the DUR (Drug Utilization Review)?
✔✔ To check for appropriate, safe, and effective medication use.
Which government program provides pharmacy coverage for elderly and disabled patients?
✔✔ Medicare.
What is the difference between copay and coinsurance?
✔✔ Copay is a fixed amount; coinsurance is a percentage of the cost.
Which form of pharmacy reimbursement involves a third-party payer paying directly to the
pharmacy?
✔✔ Third-party reimbursement.
What does the acronym MAC stand for in pharmacy billing?
✔✔ Maximum Allowable Cost.
Which pharmacy billing document lists all medications dispensed to a patient during a visit?
2
Reimbursement Questions and
Answers | Latest Version | 2025/2026 |
Correct & Verified
What is the primary purpose of pharmacy billing?
✔✔ To ensure accurate payment for medications dispensed.
Which form is commonly used to submit pharmacy claims to insurance companies?
✔✔ CMS-1500 or electronic claim forms.
What does the acronym NPI stand for in pharmacy billing?
✔✔ National Provider Identifier.
Which code set is used to identify diagnoses for reimbursement?
✔✔ ICD (International Classification of Diseases) codes.
Which code set is used to identify procedures for billing purposes?
✔✔ CPT (Current Procedural Terminology) codes.
1
, What is the purpose of the DUR (Drug Utilization Review)?
✔✔ To check for appropriate, safe, and effective medication use.
Which government program provides pharmacy coverage for elderly and disabled patients?
✔✔ Medicare.
What is the difference between copay and coinsurance?
✔✔ Copay is a fixed amount; coinsurance is a percentage of the cost.
Which form of pharmacy reimbursement involves a third-party payer paying directly to the
pharmacy?
✔✔ Third-party reimbursement.
What does the acronym MAC stand for in pharmacy billing?
✔✔ Maximum Allowable Cost.
Which pharmacy billing document lists all medications dispensed to a patient during a visit?
2
