Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
chapter 13
Pharmacy billing and inventory management
| Question | Answer |
|---|---|
| Adjudication | Electronic insurance billing for medication payment |
| Average wholesale price (AWP) | The average price at which a drug is sold |
| Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) | A program for veterans with permanent service-related disabilities and their dependents and for the spouses and children of veterans who died of service-connected disability |
| Closed formulary | Tight restriction of medication use to the medications included on the formulary list; medications that are not listed as preapproved drugs |
| Copayment | The portion of the prescription bill that the patient is responsible for paying |
| Deductible | The amount paid by a policyholder out of pocket before the insurance company pays a claim |
| Direct manufacturer ordering | Pharmacies may join a group purchasing organization and contract directly with the manufacturer to obtain better pricing |
| Drug utilization evaluation (DUE) or review (DUR) | ) An ongoing review by a pharmacist of the prescribing, dispensing, and use of medications, based on predetermined criteria, to decide whether changes need to be made in a patient’s drug therapy |
| Formulary | A list of preapproved medications that are covered under a prescription plan or within an institution |
| Health Insurance Portability and Accountability Act (HIPAA) | Federal guidelines for the protection of a patient’s personal health information |
| Health Maintenance Organization (HMO) | An insurance plan that allows coverage for in-network only physicians and services and uses the primary care physician (or provider) as the “gatekeeper” for the patient’s health care |
| Inventory | The amount of product a pharmacy has for sale |
| Just-in-time ordering | A system that orders a product just before it is used |
| Medicaid | A government-managed insurance program that provides health care services to low-income children, the elderly, the blind, and those with disabilities |
| Medicare | A government-managed insurance program composed of several coverage plans for health care services and supplies |
| Medicare Modernization Act (MMA) | The enactment of prescription drug coverage provided for individuals covered under Medicare |
| Medigap plan | Supplemental insurance provided through private insurance companies to help cover costs not reimbursed by the Medicare plan, such as coinsurance, copays, and deductibles |
| National Drug Code (NDC) | A 10-digit number given to all drugs for identification purposes |
| National Provider Identifier (NPI) | A 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 |
| Patient profile | A document listing necessary patient personal and health information, including comprehensive information on the medications the patient is taking, disease states, and any food or drug allergies the person might have |
| Periodic automatic replenishment (PAR) | The PAR of stock levels to a certain number of allowed units |
| Pharmacy and therapeutics committee (P&T committee) | Medical staff composed of physicians, pharmacists, pharmacy technicians, nurses, and dieticians who provide necessary information and advice to the institution or insurer on whether a drug should be added to a formulary |
| Point of sale (POS) | A system that allows inventory to be tracked as it is used |
| Preferred provider organization (PPO) | An insurance plan in which patients choose a provider from a specified list, resulting in reduced costs for medical services |
| Prime vendor | A large distributor of medications and retail products that contracts with the pharmacy to deliver the bulk of their medications in exchange for lower prices |
| Prior authorization | Insurance-required approval for a restricted, nonformulary, or noncovered medication before a prescription medication can be filled |
| Safety Data Sheets (SDSs) | Information sheets supplied to the pharmacy from the manufacturer of chemical products |
| Trade, brand, or proprietary drug name | The name a company assigns for marketing and identification purposes to a commercial drug product |
| Treatment authorization request (TAR) | The process used by Medicare and Medicaid for authorization of assistive technology devices costing more than $100 |
| TRICARE (formerly CHAMPUS) | A health benefit program for active duty and retired personnel in all seven uniformed services |
| Wholesalers | Companies that stock a variety of drug manufacturers’ medications and normally have a “just-in-time” turnaround for ordered drugs |
| Workers’ compensation | Government-required and government-enforced medical coverage for workers injured on the job, paid for by the employer |
Created by:
zeedizzle