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Chapter 13 Vocab
Question | Answer |
---|---|
Adjudication | Electronic insurance billing for medication payment |
Average Wholesale Price (AWP) | The average price at which a drug is sold |
Closed Formulary | Medication use is tightly restricted to the medications provided by the formulary list |
Co-pay | The portion of the prescription bill that the patient is responsible for paying |
Drug Topic Red Book | Reference book listing NDC numbers, manufactures, and AWP of drug products |
Drug Utilization Evaluation/Review (DUE) (DUR) | The process by which pharmacist ensure proper medication utilization |
Formulary | A list of preapproved medications that are covered under a prescription plan or within an institution |
Health Insurance Portability and Accountability Act (HIPPA) | Federal guidelines for the protection of a patients personal health data |
Material Safety Data Sheet (MSDS) | Information sheets supplied to the pharmacy from the manufacturer of chemical products and how to handle accidental exposure to them |
Medicare Modernization Act (MMA) | The enactment of prescription drugs covered for persons covered under Medicare and set limitations on how much they had to pay |
National Drug Code (NDC) | 10 digit number given to all drugs for identification purposes |
National Provider Identifier (NPI) | number assigned to any health care provider that is used for the purpose of standardizing health data transmissions |
Open Formulary | A formulary list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and reimbursed under the health provider plan or pharmacy benefit plan |
PAR | Periodic automatic replacement of stock levels to a certain number of units allowed |
Patient Profile | A document listing the necessary patient personal and health information including comprehensive information on the medication they are taking |
Pharmacy and Therapeutics Committee | Medical staff composed of physicians and pharmacist who provide necessary information and advice to an institution or insurer if a medication should be added to the formulary |
POS | Point of Sale or Point of Service |
Prior Authorization | Insurance-required approval for a restricted, non-formulary, or non-covered medication before a prescription medication can be filled |
Trade/Brand/proprietary name | The name a company assigns for marketing and identification purposes to a commercial drug product |
Treatment Authorization Request (TAR) | similar to the preauthorization form but used for Medicare and Medicaid |
HMO | Health maintenance organization |
Medicare | Government-managed insurance program composed of several coverage plans for health care services and supplies funded by government and state; must be 65+, younger if have long-term disability's or suffering from end-stage renal disease |
Medicaid | Government-managed insurance program that supplements Medicare if the individual meets specific requirements; for low-income, the elderly, blind, and those with disability's |
Medigap Plans | Supplement insurance polices provided through private insurance programs to help cover the cost not reimbursable by Medicare plan such as co-pay, co-insurance, and deducible |
PPO | Preferred provider organization |
Workers Compensation | Government-required and government-enforced medical coverage for workers injured on the job paid for by the employers managed by each sate depending on their work compensation laws |