permission granted by health plan after they have determined a procedure or medications is medically necessary. Usually for high-cost procedures or meds.

Coordination of benefits

the order in health plans are requested to pay for medication for a patient with multiple health plans

when a health plan decides if a drug is covered and how much they will and the patient must pay for a covered drug

when a health plan representative visits a pharmacy and requests records of claims filed with their health plan. Looks for errors and determines penalties should errors be found.

a list of drugs Medicare must cover even though usually high-cost medications

Medication therapy management

a service pharmacies must provide to Medicare and Medicaid patients that educates patients about their meds, reviews medications, and helps ensure patient compliance with medication therapy regimens.

Parkinson’s disease

progressive neurological disease marked by a lack of muscle control, stiffening or slowing of movement, linked to a lack of dopamine

Alzheimer’s disease

progressive disease that affects memory, thought, and language that is linked to a lack of acetylcholine. It is the most common cause of dementia in geriatric patients. Advanced form of disease can lead to patient’s death.

sudden, uncontrolled burst of electrical activity in the brain

jerking, uncontrolled muscle spasms

Tonic clonic seizures

generalized seizures characterized by convulsions “grand mal”

generalized seizures characterized by a sudden loss of consciousness, “petit mal”

recurrent or continuous seizures over 5 minutes period or longer without a regaining normal level of consciousness. Considered a true medical emergency.

neurological disorder characterized by recurrent severe headaches caused by overexcitement of nerves that branch out form the brainstem and blood vessel dilation.

a deliberate deception or misrepresentation that results in an unauthorized reimbursement or deliberate actions that are inconsistent with accepted medical or business practices

unnecessary costs or the misuse of resources, without the intention to commit a fraudulent act

treatment, payment, and healthcare operations

National Council for Prescription Drug Programs

Health Insurance Portability and Accountability Act

Help

Options

focusNode

Didn't know it?
click below

Knew it?
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

Stack #4091854

PhT 2 Week 3 Terms & Abbr

Term	Definition
Preauthorization	permission granted by health plan after they have determined a procedure or medications is medically necessary. Usually for high-cost procedures or meds.
Coordination of benefits	the order in health plans are requested to pay for medication for a patient with multiple health plans
Adjudication	when a health plan decides if a drug is covered and how much they will and the patient must pay for a covered drug
Field audits	when a health plan representative visits a pharmacy and requests records of claims filed with their health plan. Looks for errors and determines penalties should errors be found.
Protected drugs	a list of drugs Medicare must cover even though usually high-cost medications
Medication therapy management	a service pharmacies must provide to Medicare and Medicaid patients that educates patients about their meds, reviews medications, and helps ensure patient compliance with medication therapy regimens.
Parkinson’s disease	progressive neurological disease marked by a lack of muscle control, stiffening or slowing of movement, linked to a lack of dopamine
Alzheimer’s disease	progressive disease that affects memory, thought, and language that is linked to a lack of acetylcholine. It is the most common cause of dementia in geriatric patients. Advanced form of disease can lead to patient’s death.
Seizure	sudden, uncontrolled burst of electrical activity in the brain
Convulsions	jerking, uncontrolled muscle spasms
Tonic clonic seizures	generalized seizures characterized by convulsions “grand mal”
Absence seizures	generalized seizures characterized by a sudden loss of consciousness, “petit mal”
Status epilepticus	recurrent or continuous seizures over 5 minutes period or longer without a regaining normal level of consciousness. Considered a true medical emergency.
Migraines	neurological disorder characterized by recurrent severe headaches caused by overexcitement of nerves that branch out form the brainstem and blood vessel dilation.
fraud and abuse	a deliberate deception or misrepresentation that results in an unauthorized reimbursement or deliberate actions that are inconsistent with accepted medical or business practices
waste	unnecessary costs or the misuse of resources, without the intention to commit a fraudulent act
PHI	protected health information
EHR	electronic health record
EMR	electronic medical record
TPHCO	treatment, payment, and healthcare operations
NCPDP	National Council for Prescription Drug Programs
NPI	National Provider Identifier
EDI	electronic data interchange
NOPP	Notice of Privacy Practices
BCBS	Blue Cross Blue Shield
COB	coordination of benefits
TMR	targeted medication review
MTM	medication therapy management
HIPAA	Health Insurance Portability and Accountability Act
PBM	Pharmacy Benefits Manager
PA	Prior Authorization

Created by: CPhTcindyjacksWTI

"Know" box contains:
Time elapsed:
Retries: