Coronavirus (COVID-19) Update: Online exam delivery is offered for all PTCB credentials. In-person testing is available on a limited basis at some test centers. Learn more.

Billing and Reimbursement Certificate

Feature your advanced understanding of third-party payers and reimbursement systems utilized within the pharmacy.

INTRO

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Expertise managing billing and reimbursement is crucial in the pharmacy setting. However, this competency is often lacking or learned through experience that allows a tech to solve only a few specific issues without developing a broad foundation.

Earning the PTCB Billing and Reimbursement Assessment-Based Certificate will demonstrate that you not only have the necessary foundational knowledge but you are capable of playing a leadership role in this crucial administrative function for a pharmacy, which helps patients access medication.

Complete the Billing and Reimbursement Certificate to demonstrate your competency in:

  • Insurance programs and eligibility requirements
  • Claim processing and adjudication
  • Prior authorizations
  • CMS audits and contract compliance

 

APPLY TESTING DURING COVID-19

 

 

 

PREPARE & APPLY

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Eligibility Requirements

A candidate must hold an active PTCB CPhT Certification and fulfill one of the following eligibility pathways:

Pathway 1: Completion of a PTCB-Recognized Billing and Reimbursement Education/Training Program and at least 6 months of experience as a pharmacy technician.

Pathway 2: At least 12 months of pharmacy technician experience; at least 50% of which must be devoted to pharmacy billing and reimbursement activities.

 

A Step Toward Your Advanced CPhT (CPhT-Adv) 

Active PTCB CPhTs who have completed at least four of the certificate programs (including TPV and/or Medication History), or three certificate programs and the Compounded Sterile Preparation Technician (CSPT) Certification, and 3 years of work experience will be eligible to earn a CPhT-Adv in late 2020.

 

Educational Requirement

One of the eligibility pathways for this certificate program includes completing a PTCB-Recognized Education/Training Program for the Billing and Reimbursement Certificate. PTCB Recognized Education/Training Programs meet the curriculum requirements as documented by PTCB.

View a list of PTCB-Recognized Education/Training Programs for the Billing and Reimbursement Certificate.

Please note that additional PTCB-Recognized Education/Training Programs for Billing and Reimbursement will be added to the list as they become available.

 

Exam Fee

The cost to apply for the Billing and Reimbursement Certificate is $89.

Being an early applicant means you’ll save money! Save $30 for the first 3 months: Pay $59 when you apply by October 20!

 

How to Apply and Schedule

  1. Log into your PTCB Account.
  2. Visit PTCB’s Credential Center (within your PTCB Account) and apply.
  3. Once your application is approved, you will receive an email with your authorization to schedule your exam.
  4. The Billing and Reimbursement Certificate Exam is administered year‐round at more than 1,400 Pearson Professional Centers nationwide, including more than 100 military on-base sites.

 

Prepare for Your Exam

Be sure to review the exam content outline as part of your exam preparation.

Programs and Eligibility (20%)
Programs and eligibility terminology
Third-party reimbursement types (e.g., PBM, medication assistance programs, self-pay)
Healthcare reimbursement systems in different settings (e.g. home health, long-term care, home infusion, health systems, community pharmacy, and ambulatory clinics)
Eligibility requirements for private and/or federally-funded insurance programs (e.g., Medicare, TRICARE, Medicaid)
Eligibility for patient assistance through available programs (eg. a 340B eligible program)
Claims Processing and Adjudication​ (48%)
Pharmacy/medical claim processing terminology
Information needed to submit pharmacy/medical claims
General pharmacy claim submission process (e.g., data entry, verification, adjudication)
Third-party claim rejection trouble-shooting and resolution
Methods for determining drug cost and sale prices (e.g., AWP, dispensing fees, gross and net profit, acquisition cost
Coordination of benefits or plan limitations to determine each party’s responsibility
Reimbursement policies for all plans being billed, regardless of contracted payers, HMOs, PPO, CMS, or commercial plans
Identification of formulary coverage or alternatives
340B terminology
Prior Authorization (20%)
Prior authorization terminology
Information needed to submit medical/pharmacy prior authorization (e.g., patient and prescriber information, drug, dose)
General process of prior authorization (e.g., from formulary alternatives to contacting the provider, then through payer to patient)
Third-party prior authorization rejection trouble-shooting and resolution
Audits and Compliance (12%)
Audit and compliance terminology
Contract documentation for claims billed to specific insurance plans (e.g., ICD-10 codes, provider feedback and authorizations to change medications)
Federal laws/regulations regarding audits (e.g., mandated audits by CMS for all government funded programs)
Accrediting bodies and surveys (e.g., URAC, TJC, CMS, DNV)

Prepare for the Billing and Reimbursement Exam
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TAKE THE EXAM

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About the Exam

The Billing and Reimbursement Certificate Exam is a computer-based exam with 70 multiple-choice questions. Be prepared to commit 2 hours for the exam (10 minute tutorial and survey, 1 hour and 50 minute exam).

 

Exam Day Requirements

Arrive at the designated Pearson VUE test center 30 minutes before your appointment. Bring an approved form of identification that matches your name as it appears on your PTCB Account. You will not be allowed to take the exam without proper identification. Be sure to review more detail about what to expect and what is required in the Candidate Guidebook.

Taking the exam online? Learn more

 

Testing Accommodations

Candidates who require testing accommodations must request these accommodations during the application process. Accommodations that are reasonable and consistent with the Americans with Disabilities Act (ADA) will be provided by PTCB at no additional cost to candidates. Candidates who need to bring medical equipment into the testing room need to request an accommodation if the item is not on the list of allowed items.

Exam Day
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EARN YOUR CERTIFICATE

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Scoring

Exams will be scored in the coming months and only those who achieve a passing score will earn the Billing and Reimbursement Certificate. Exam results will be available 3 to 4 months following the July 20 launch of this certificate program. Because the Billing and Reimbursement Assessment-Based Certificate Program is new, scoring will be delayed. PTCB will apply the same rigorous process to determine the passing score for the Billing and Reimbursement Exam after multiple candidates have tested.

 

Digital Badges

Upon earning your credential, you will receive an email invitation from the Acclaim Platform via badge@ptcb.org with instructions for claiming your badge and setting up your account. 

This digital badge will contain information describing your credential, including how you earned it. You can display the badge in your email signature, electronic files of a resume, and on social media sites like LinkedIn, Facebook, and Twitter.

 

Certificates

Once your official score is available, you can download your certificate through the Acclaim Platform. Learn more.

Earn Your Billing and Reimbursement Certificate
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RENEW

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This certificate program does not require renewal.

DOCUMENTS

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Quick access to additional documents you may need during your PTCB Billing and Reimbursement Certificate process. Download the necessary documents and submit the completed forms as required.

  1. Testing Accommodations Form