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audit a challenge on a reimbursement from a PBM or insurance provider on a prescription claim that has been previously processed
average wholesale price (AWP) the average price that wholesalers charge the pharmacy for a drug
certificate of medical necessity form to be completed and signed by the prescriber for Medicare Part B insurance payment for diabetic supplies
charge-back a rejection of a prescription claim by a PBM or an insurance provider that must be investigated and resolved
co-insurance a percentage-based insurance plan in which the patient must pay a certain percentage of the prescription price
computer an electronic device for inputting, storing, processing, and/or outputting information
coordination of benefits (COB) online billing of both a primary and a secondary insurer
co-payment (co-pay) the amount that the patient is to pay for each prescription as determined by insurance
credit card a method of online payment that is a type of loan, either paid totally at the end of the month or partially with a finance charge added
database management system (DBMS) application that allows one to enter, retrieve, and query records
days' supply the duration of time (number of days) a dispensed medication will last a patient; required on drug claims submitted for insurance billing
debit card a method of online cash payment that instantly deducts the cost of the purchase from the customer's bank account
deductible an amount that must be paid by the insured before the insurance company considers paying its portion of a medical or drug cost
dietary supplement a category of nonprescription drugs that includes vitamins, minerals, and herbals that are not directly regulated by the FDA like OTC drugs
discount a reduced price
donut hole insurance coverage gap in Medicare Part D programs by which the patient must pay a higher portion of the cost of the medication
dual co-pay insurance coverage in which a patient pays one co-pay for brand name drugs and a lower co-pay for generic drugs
dumb terminal a computer device that contains a keyboard and a monitor but does not contain its own storage and processing capabilities
durable medical equipment (DME) medical equipment such as hospital beds, wheelchairs, canes, or crutches that may be covered under Medicare Part B insurance
Flex card a medical and prescription insurance credit card
gross profit the difference between the purchase price and the selling price; also called markup
health insurance coverage of incurred medical costs such as physician visits, laboratory costs, and hospitalization
inventory the entire stock of products on hand for sale at a given time
inventory turnover rate the amount of time the average drug inventory will be replaced during a 12-month period; most pharmacies replace inventory every two to four weeks
inventory value the total value of the entire stock of products on hand for sale on a given day
just-in-time (JIT) purchasing frequent purchasing in quantities that just meet supply needs until the next ordering time
markup the difference between the purchase price and the selling price; also called gross profit
Medicaid a state government health insurance program for low-income and disabled citizens
Medicare Part D a voluntary insurance program that provides partial coverage of prescriptions primarily for patients who are eligible for Medicare
nondurable medical supplies consumable, disposable items that can only be used by one patient for a specific purpose
online adjudication real-time insurance claims processing via wireless telecommunications
out of stock (OOS) a situation in which the pharmacy does not have the prescribed drug in inventory
over-the-counter (OTC) drug a medication that the FDA has approved for sale without a prescription; another name for nonprescription drug
partial fill a situation in which the pharmacy cannot completely fill the prescribed quantity written on the prescription
perpetual inventory record a record that accounts for each unit of Schedule II drug dispensed or received
prescription benefits manager (PBM) a company that administers drug benefits from many insurance companies
posting the process of reconciling the invoice and updating inventory at time of receipt
preferred drug list a formulary provided by an insurance company that indicates preferred prescription generic and brand name drugs and their corresponding co-pays
prime vendor purchasing an agreement made by a pharmacy for a specified percentage or dollar volume of purchases
prior authorization (PA) approval for coverage of a high-cost medication or a medication not on the insurer's approved formulary
private insurance coverage for medical or prescription costs provided by an employer or purchased by an individual
profit the amount of revenue received that exceeds the expense of the sold product, services, and overhead
purchasing the ordering of products for use or sale by the pharmacy
receipt a printout that is a proof of purchase
receiving a series of procedures for accepting the delivery of products to the pharmacy from a wholesaler or centralized warehouse
remote computer a minicomputer or a mainframe that stores and processes data sent from a dumb terminal
Schedule V drug a medication with a low potential for abuse and a limited potential for creating physical or psychological dependence; available in most states without a prescription
sharps any needle, lancet, scalpel blade, or other medical equipment that could cause a cut or puncture
smart terminal a computer that contains its own storage and processing capabilities
smurfing a practice that occurs when a patient is paid cash by an individual to illegally purchase pseudoephedrine from more than one pharmacy
tiered co-pay insurance coverage in which the patient has an escalating cost or co-pay, depending on whether the filled prescription is a generic drug, a preferred brand name drug, or a nonpreferred brand name drug
Tricare a federal government health insurance program for active and retired military personnel and their dependents
uninsured patients with no insurance who must pay out-of-pocket for medical and/or prescription costs
usual and customary charges the total cost of dispensing a prescription to the general public; a pharmacy cannot bill government insurance programs more than the usual and customary charge
wholesaler purchasing the ordering of drugs and supplies from a local vendor who delivers the product to the pharmacy on a daily basis
workers' compensation insurance provided for a patient with a medical injury from a job-related accident; also called workers' comp
Created by: softcrylic