PTCB Billing & Reimbursement case studies
PTCB Billing & Reimbursement · Put your knowledge to work in context.
The PTCB Billing and Reimbursement certificate is a credential for pharmacy technicians who want to show competence in the business side of pharmacy - the part of the workflow between a prescriber's order and a paid claim. It fits technicians already working in community, specialty, or mail-order settings, and those moving from dispensing duties into billing, prior authorization, or revenue-cycle work. The PTCB Billing & Reimbursement case studies are 5 cases and about 2,433 words.
1Work Injury, Two Cards, and an Out-of-Network Payer
A 42-year-old patient arrives at an independent pharmacy with a prescription for hydrocodone/acetaminophen 5/325 mg, 40 tablets, directions 1 tablet every 6 hours as needed for pain, written by an urgent care physician. The patient says the injury happened on a forklift at work yesterday.
480 words, about 2 min2NDC Rejection and a Partial Package
A prescription for levothyroxine 50 mcg tablets, 1 tablet by mouth daily, 30-day supply, arrives electronically. The pharmacy stocks two generic NDCs: NDC A in a 500-count bottle and NDC B in a 100-count bottle.
495 words, about 2 min3Dual Eligible: Part D Copay and Medicaid Secondary
A 68-year-old patient has Medicare Part D and full Medicaid. They present a prescription for a 30-day supply of a Part D-covered brand drug.
479 words, about 2 min4Step-Therapy Denial and Appeal Documentation
A prescriber sends a new prescription for adalimumab 40 mg/0.8 mL subcutaneous every other week for a patient with moderate-to-severe Crohn's disease. The patient's commercial plan requires step therapy with a conventional immunosuppressant before adalimumab.
487 words, about 2 min5Refill Too Soon and a Vacation Override
A patient presents for an early refill of oxycodone/acetaminophen 5/325 mg, 1 tablet every 6 hours as needed, quantity 30, days supply 30. The last fill was 22 days ago.
492 words, about 2 min