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Stack #999709

Chapter 6

The basic ways in which the pharmacy can receive payment for service are: 1) self-pay 2) third-party payer
What is self-pay? The patient pays the pharmacy directly.
Methods of third-party pay: The patient can pay the pharmacy and be () (), in which case the pharmacist must fill out an (), stating the drug (), (), and other needed info. reimbursed, out-of-pocket, insurance affidavit, received, price
Methods of third-party pay: The patient can pay a small payment (aka--() ), and the pharmacy () the () for the () or the charge. co-payment or co-pay; bills, insurance company, balance
The () needs to be familiar with the () of (). technician; billing; third-party payers
Third-party payers include: (), (), and (). traditional insurance companies, government plans, private insurance companies
Give an example of traditional insurance. Received under an employee benefit package
Give examples of government plans. Medicare, Medicaid
Each healthcare plans has specific () and may or may not include (). benefits, payment for medications
Healthcare plans that do cover prescription meds may () in various ways. limit coverage
List ways that a healthcare plan would limit coverage. 1) Exclusion of outpatient prescriptions 2) Outpatient coverage to oral dosage forms 3) Exclusion of proprietary drugs/brand names/trade 4) Limitations on quantity
Insurance coverage must be () at the time the prescription is (). verified, received
Some insurance companies only allow () to be dispensed. generic drugs
Once insurance coverage has been established, the () to be submitted to the () must be () and (), and the () (). forms, insurance company, identified, completed, medication calculated
In a(n) () setting, charges for medication are billed to the () () as the medication is (). institutional, patient's account, dispensed
The () of a medication begins with the cost of the medication to the () aka the (). selling price, pharmacy, cost price
The () price is () by a certain () or () to the () price. cost, increased, percent, dollar amount, selling
All medications dispensed by () will also include a () (may be a () of the price or a () added to the cost). prescription, dispensing fee, percent, flat fee
The mark-up rate or mark-up percent of a drug is normally expressed as a (). percent of the cost
Example of mark-up rate: A mark-up of 100% would mean that the () in price would be equal to (). increase, cost price
The mark-up of a drug is not the same as the () that is made on the drug. profit
The cost of (), (), and general overhead expenses must be taken into account when calculating the (). inventory, storage, actual profit made
Created by: yquyenvu