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Mod 1 Week 3

Chp 14 PT

QuestionAnswer
What is the federal health insurance program for people over age 65 or people with kidney failure called? Medicare
An example of an automated point of use storage system for making floor stock items available to nurses in a hospital setting is called? Pyexil supply station
If a drug is not covered on the patient's formulary you would recieve the--------- rejection? NDC not covered
Osha required notices on hazardous substances to provide hazard, handling, and clean-up and first aid information are called what? MSDS (Material Safety Data Sheet)
The maximum amount of cost that will be covered for a prescription as determined by the insurance plan is called? UCR (Usual Customary Reasonable) or U&C (Usual and Customary)
The type of managed care program that is most restrictive is? HMO (Health Maintenance Organization)
A inventory system in which the item is deducted from inventory as it is sold or dispensed is called? POS(Point Of Sell or Sale)
the number used to identify the drug dispensed when billing a PBM for a filled prescription is NDC (National Drug Code)
what form is used prior authorization only for patients on California Medi-Cal TAR (Treatment Authorization Requires)
The U.S. government agency that regulates DEA (Drug Enforcement Administration)
An agreement for cost sharing between the insurer and insured co-insurance
Employer compensation program for employees accidentally injured on the job workman's-compensation
A company that administers drug benefit programs for insurance companies or employer PBM(Pharmacy Benefit Manager)
Another party, besides the patient or the patient or the pharmacy, that pays for some or all of the cost of a medication Third Party Billing
Programs sponsored by pharmaceutical manufacturers to help provide medications for the needy Patient Assistant Program
A portion of the price of medication that the patient is required to pay co-pay
A listing of the medications that are approved for use within a system formulary
The rate which inventory is used, generally expressed in number of days Turnover rate
Process for using a computer to determine the exact to coverage for a prescription with the appropriate third party Online Adjudication
DAW 1 maeans Dispense As Written by the prescriber
A NPI number is assigned to recognized Healthcare provider
A federal-state program that covers health expense medciade
Offered by some pharmaceutical manufacturers to help needy patients who require medications they cannot afford and do not have insurance cover Patient Assistance Programs
The maximum price per tablet an insurer or PBM will pay for a given product Maximum allowable cost
Federal Health program which covers people over 65, disabled people under 65, and people with kidney failure Medicare
A company that administers drug benefit programs PBM(Pharmacy Benefit Manager)
Standard claim form accepted by many insurers Universal Claim Forms
Information given on a prescription benefit card which basically helps route electronic pharmacy insurance claims in the right general direction BIN number
An agreement between the insurer and the insured to share costs co-insurance
Process for using a computer to determine the exact coverage for a prescription with the appropriate third party online adjudication
The CPT Codes for biling Medication Therapy Management Services provided by pharmacists are? 99605,99606,99607
A standard form used by healthcare providers to bill for services is? CMS-1500
A (an)______is a network of providers where costs outside the network may be partially reimbursed and the patient's primary care physician need not be a member. PPO
Which type of managed care program is least likey to require generic substitution? PPO
Created by: Rodney C
Popular Pharmacology sets

 

 



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