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Stack #999709
Chapter 6
| Question | Answer |
|---|---|
| The basic ways in which the pharmacy can receive payment for service are: | 1) self-pay 2) third-party payer |
| What is self-pay? | The patient pays the pharmacy directly. |
| Methods of third-party pay: The patient can pay the pharmacy and be () (), in which case the pharmacist must fill out an (), stating the drug (), (), and other needed info. | reimbursed, out-of-pocket, insurance affidavit, received, price |
| Methods of third-party pay: The patient can pay a small payment (aka--() ), and the pharmacy () the () for the () or the charge. | co-payment or co-pay; bills, insurance company, balance |
| The () needs to be familiar with the () of (). | technician; billing; third-party payers |
| Third-party payers include: (), (), and (). | traditional insurance companies, government plans, private insurance companies |
| Give an example of traditional insurance. | Received under an employee benefit package |
| Give examples of government plans. | Medicare, Medicaid |
| Each healthcare plans has specific () and may or may not include (). | benefits, payment for medications |
| Healthcare plans that do cover prescription meds may () in various ways. | limit coverage |
| List ways that a healthcare plan would limit coverage. | 1) Exclusion of outpatient prescriptions 2) Outpatient coverage to oral dosage forms 3) Exclusion of proprietary drugs/brand names/trade 4) Limitations on quantity |
| Insurance coverage must be () at the time the prescription is (). | verified, received |
| Some insurance companies only allow () to be dispensed. | generic drugs |
| Once insurance coverage has been established, the () to be submitted to the () must be () and (), and the () (). | forms, insurance company, identified, completed, medication calculated |
| In a(n) () setting, charges for medication are billed to the () () as the medication is (). | institutional, patient's account, dispensed |
| The () of a medication begins with the cost of the medication to the () aka the (). | selling price, pharmacy, cost price |
| The () price is () by a certain () or () to the () price. | cost, increased, percent, dollar amount, selling |
| All medications dispensed by () will also include a () (may be a () of the price or a () added to the cost). | prescription, dispensing fee, percent, flat fee |
| The mark-up rate or mark-up percent of a drug is normally expressed as a (). | percent of the cost |
| Example of mark-up rate: A mark-up of 100% would mean that the () in price would be equal to (). | increase, cost price |
| The mark-up of a drug is not the same as the () that is made on the drug. | profit |
| The cost of (), (), and general overhead expenses must be taken into account when calculating the (). | inventory, storage, actual profit made |
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yquyenvu
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