Acronyms Flashcards
(41 cards)
HMO
Health Maintenance Organization (HMO) Act:
This act required employers with more than 25 employees to offer an HMO option in their health plans.
HMOs typically require members to select a Primary Care Physician (PCP) from within the network. You need a referral from your PCP to see specialists or receive non-emergency care from specialists. Out-of-network coverage is usually limited to emergency care or specific situations defined by the plan. HMOs typically cover preventive care services, such as vaccinations and screenings, at no cost to the member.
PPOs
PPO (Preferred Provider Organization):
No PCP Requirement:
PPOs do not require members to choose a Primary Care Physician (PCP) or obtain referrals to see specialists. Members can directly schedule appointments with specialists.
Provider Choice:
PPO plans still provide coverage for services obtained from out-of-network providers, but the coverage is usually less generous.
Out-of-Network Coverage:
While PPOs provide coverage for out-of-network care, it is generally at a reduced rate. Members may have higher deductibles and coinsurance for out-of-network services.
HIPAA
Health Insurance Portability and Accountability Act :
Privacy regulations to protect patients’ personal health information.
Portability rules allowing individuals to maintain health coverage when changing jobs.
Anti-discrimination provisions to prevent health insurance discrimination based on health status.
S-CHIP
S-CHIP, later known as CHIP (Children’s Health Insurance Program), was established to provide health insurance coverage to low-income children who did not qualify for Medicaid but lacked access to private insurance.
MMA
The MMA created Medicare Part D, a prescription drug benefit program for Medicare beneficiaries. This expanded Medicare’s coverage to include prescription medications.
Medicare Part D provides prescription drug coverage through private insurance plans approved by Medicare.
ACPE
Accreditation council for pharmacy education
NABP
North American Board of Pharmacy
COC
coordination of care
refers to the process of organizing and managing a patient’s healthcare services and resources to ensure they receive comprehensive and seamless care.
COC (2)
Continuity of care is the concept that healthcare should be provided consistently and without interruptions over time.
PCP
Primary Care Provider
CDTM
collaborative drug therapy management.
is a practice in healthcare where pharmacists work closely with other healthcare providers, such as physicians, nurse practitioners, and other prescribers, to manage and optimize drug therapy for patients.
CMR
(Comprehensive Medication Review):
A CMR is a thorough review of a patient’s medications, including prescription and over-the-counter drugs, to ensure they are safe, effective, and appropriate for the patient’s health conditions. It often involves a pharmacist or healthcare provider.
MTM
(Medication Therapy Management):
MTM is a service provided by pharmacists to optimize medication therapy for patients. It includes medication reviews, medication counseling, and personalized care plans to improve health outcomes.
MR
Medication Review is a process where a healthcare professional evaluates a patient’s medications to ensure they are being used correctly and effectively. It may involve identifying and resolving drug-related problems.
EOB
(Explanation of Benefits):
EOB is a document sent by health insurance companies to policyholders, explaining the costs and benefits associated with a specific medical claim. It details what the insurance will cover and what the patient is responsible for paying.
ACA
(Affordable Care Act):
The ACA, also known as Obamacare, is a major U.S. healthcare reform law enacted in 2010. It aimed to increase access to healthcare, regulate insurance practices, and improve healthcare quality and affordability
PPACA
(Patient Protection and Affordable Care Act):
PPACA is the full name of the ACA (Affordable Care Act), emphasizing its focus on protecting patients and making healthcare more affordable.
UM
(Utilization Management):
UM is a healthcare process used to ensure that medical services and treatments are appropriate, necessary, and cost-effective. It involves reviewing and managing healthcare utilization.
UR
(Utilization Review):
UR is a component of utilization management that involves the systematic evaluation of the medical necessity, appropriateness, and efficiency of healthcare services provided to patients.
PA (insurance)
(Prior Authorization):
PA is a requirement by health insurance plans for certain medications or treatments. Before they are covered, a prescriber must obtain approval from the insurance company.
DUR
(Drug Utilization Review):
DUR is a process used to assess and monitor the use of medications. It helps ensure that medications are used safely and effectively.
DUE
(Drug Use Evaluation):
DUE is a structured review of medication use in a healthcare setting to assess and improve the quality of drug therapy and patient outcomes.
DRP
(Drug-Related Problem):
A DRP refers to any issue or concern related to a patient’s medication therapy, such as adverse reactions, drug interactions, or non-adherence.
DRM
DRM refers to the negative health effects or illnesses caused or exacerbated by the use of medications.
