Florida Pharmacy Technician Certification Practice Test

What does the term "Coordination of Benefits" refer to?

1. Billing two plans for the same claim

2. Private Insurance management

3. HealthSavings Pass program usage

4. Medicaid eligibility determination

The correct answer is: Billing two plans for the same claim

The term "Coordination of Benefits" refers to the process used when a patient is covered by multiple insurance plans and seeks to ensure that the total benefits paid from all sources do not exceed the total cost of the healthcare services provided. This typically involves billing two or more insurance plans for the same claim to determine which one pays first and how much the other one will contribute thereafter. The goal is to optimize the coverage the patient receives, while the insurance companies work together to prevent overpayment or duplication of benefits. This process is essential in situations where a patient may have primary insurance through their employer and secondary insurance through a spouse, for example. Proper coordination allows healthcare providers to receive appropriate payment without the patient being penalized. In contrast, the other options do not accurately capture this concept: private insurance management pertains to the administration of private health insurance plans, not the interplay between multiple plans; the HealthSavings Pass program is a specific discount card program rather than a method of coordinating benefits; and Medicaid eligibility determination refers to assessing a person's qualifications for Medicaid, which does not involve the interaction of multiple insurance policies.