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PHM 101
Chapter 13 and 14 Vocabulary
| Word | Definition |
|---|---|
| Inventory | a list of goods or items a business uses in its normal operations |
| Formulary | a list of medications approved for use |
| Open Formulary | a system that allows a pharmacy to use any prescribed medication |
| Closed Formulary | a limited list of approved medications |
| Therapeutic Equivalent | pharmaceutical equivalents that produce the same effects in patients |
| Perpetual Inventory | a system that maintains a continuous record of every item in inventory so that it always shows the current amount of stock on hand |
| Turnover | the rate at which inventory is used,generally expressed in number of days |
| Point of Sale System- POS | an inventory system in which the item is deducted from inventory as it is sold or dispensed |
| Reorder Points | minimum and maximum stock levels which determine when a reorder is placed and for how much |
| Automated Dispensing System | a system in which medications are dispensed, upon confirmation of an order communicated from a centralized computer system, at their point of use |
| Database | a collection of information structured so that specific information within it can easily be retrieved and used |
| Material Safety Data Sheets- MSDS | OSHA required notices on hazardous substances which provide hazard, handling, clean up, and first aid information |
| Purchase Order Number | the number assigned to each order for identification |
| Unit Dose Packaging | a package containing a single dose of a medication |
| Pharmacy Benefit Managers | companies that administer drug benefit programs |
| Online Adjudication | the resolution of prescription coverage through the communication of the pharmacy computer with the third party computer |
| Co Pay | the portion of the price of medication that the patient is required to pay |
| Maximum Allowable Cost- MAC | the maximum price per tablet and insurer or PBM will pay for a given product |
| UCR | the maximum amount of payment for a given prescription, determined by the insurer to be a usual and customary price |
| Dual Co Pay | co pays that have two prices- one for generic and one for brand medications |
| Deductible | a set amount that must be paid by the patient for each benefit period before the insurer will cover additional expenses |
| Prescription Drug Benefit Cards | cards that contain third party billing information for prescription drug purchases |
| Formulary | a list of medications covered by third party plans |
| Tier | categories of medications that are covered by third party plans |
| HMOs | a network of providers for which cost are covered inside but not outside of the network |
| POSs | a network of providers where the patients primary care physician must be a member and costs outside the network may be partially reimbursed |
| PPOs | a network of providers where costs outside the network may be partially reimbursed and the patients primary care physician need not be a member |
| Medicare | a federal program providing health care to people with certain disabilities or who are over age 65; it includes basic hospital insurance, and voluntary prescription drug insurance |
| Medicaid | a federal state program, administered by the states, providing health care for the needy |
| Workers Compensation | an employer compensation program for employees accidentally injured on the job |
| Patient Assistance Programs | manufacturer sponsored prescription drug programs for the needy |
| CMS-1500 Form | the standard form used by health care providers, such as physicians, to bill for services. It can be used to bill for disease state management services and is available at http://www.cms.hhs.gov/cmsforms/downloads/cms1500805.pdf. |
| Universal Claim Form- UCF | a standard claim form accepted by many insurers |
| Medication Therapy Management Services- MTMS | services provided to some medicare beneficiaries who are enrolled in medicare part D and who are taking multiple medications or have certain diseases |
| Prescription Drug Plans- PDPs | third party programs for medicare part D |
| National Provider Identifier- NPI | the code assigned to recognized health care providers; needed to bill MTMS |
| Current Procedural Terminology Codes- CPT Codes | identifiers used for billing pharmacist-provided MTM services |
Created by:
Tara3184
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