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pharm billing & inve
ch 13 pharmacy billing and inventory management
| Term | Definition |
|---|---|
| Average Wholesale Price | Average price which a drug is sold |
| Civilian health and Medical Program of the Dept of Veteran Affairs (CHAMPVA) | A program for veterans with permanent service-related disabilities and their families |
| Closed formulary | Tigh restriction of medication uses to the medications included on the formulary list |
| Copayment | The portion of the prescription 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 or review (DUE/DUR) | An ongoing review by a pharmacist of the prescribing medication 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 institute |
| Health Maintenance Organization (HMO) | An insurance plan that allows coverage for in network only physicians and service and uses the primary care physician as the patientts 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 individuals and ones 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 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 medications 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, pharmacist, nurses, pharmacy technicians, nurses and dieticians who provide necessary information and advice to the institution |
| 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 restricted, nonformulary, or noncovered medication before a prescription medication can be filled |
| Safety Data Sheets (SDS) | Information sheets supplied to the pharmacy from the manufacturer of chemical products |
| Treatment Authorization Request (TAR) | The process used by Medicare and Medicaid for authorization of assistive technology device costing more than $100 |
| TRICARE | a health benefit program for active duty and retired personnel in all seven uniformed services |
| Wholesalers | Companies that stock a variety of drug manufactures 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 by the employer |
| Special Orders | Order of a new or uncommon drug from the wholesaler |
| Limitation of plan exceeded | A patient who has exhausted their pharmacy benefits for the specified time period or quantity limitation on a drug |
| Drug topics RED BOOK | A good source of information pertaining to average wholesale drug cost and prices |
| Third Party Billing | The portion of payment reimbursed by insurance companies |
| Medicare A | Covers institutional costs if criteria by federal and state regulations are met |
| Medicare B | Covers physician and outpatient services |
| Medicare C/Medicare Advantage | Private plan that uses Medicare and must be equal to parts A and B |
| Medicare D | Covers prescription drugs |
Created by:
lamia23
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