Vocab Review
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| co-insurance | An agreement for cost-sharing between the insurer and the insured.
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| co-pay | The portion of the medication's price that the patient is required to pay.
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| dual co-pay | Co-pays that have two prices: one for generic and one for brand names.
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| U&C or UCR | The maximum amount of payment for a given prescription, determined by the insurer to be a usual and customary (and reasonable) price.
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| deductible | A set amount that must be paid by the patient for each benefit period before the insurer will cover additional expenses.
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| tier | Categories of medications that are covered by third-party plans.
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| HMO | Costs are covered only for services from in-network providers.
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| POS | The patient's primary care physician must be a member; and costs outside the network may be partially reimbursed.
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| PPO | Cost outside the network may be partially reimbursed and the patient's primary care physician need not be a member.
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| Medicaid | A federal-state program, administered by the states, providing health care for the needy.
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| Medicare | A federal program providing health care to people with certain disabilities or who are over age 65.
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| patient assistance program | Manufacturer sponsored prescription drug programs for the needy.
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| worker's compensation | An employer compensation program for employees accidentally injured on the job.
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| prior authorization | A procedure to gain third-party coverage for a drug that is not automatically covered by a third-party plan.
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| CMS-1500 form | The standard form used by health-care providers to bill for services, including disease state management services.
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| universal claim form (UCF) | A standard claim form accepted by many insurers.
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| Current Procedural Terminology codes (CPT codes) | Identifiers used for billing pharmacist-provided MTM services.
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| National Provider Identifier (NPI) | The code assigned to recognized health-care providers; needed to bill MTM services.
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| Prescription Drug Plans (PDPs) | Third-party programs for Medicare Part D.
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