14 - Financial Issues Flashcards Preview

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Flashcards in 14 - Financial Issues Deck (7)
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1
Q

a company that administers drug benefit programs for insurance companies, HMOs, and self-insured employees

A

pharmacy benefit manager

2
Q

the maximum amount of payment for a given prescription, determined by the insurer to be a usual and customary price

A

usual & customary (U&C)

3
Q

health-care networks that usually do not cover expenses incurred outside the network and generally require generics

A

HMO

4
Q

health-care network where the patient’s primary care physician must be a member and costs outside the network mat be partially reimbursed (TCF)

A

POS

5
Q

health-care network that reimburses expenses outside the network at a lower rate than inside the network and usually requires generics

A

PPO

6
Q

health-care providers use this form to bill for services

A

CMS-1500

7
Q

form used by health0care providers to apply for an NPI

A

CMS-10114