Pharmacy Billing And reimbursement Flashcards Preview

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Flashcards in Pharmacy Billing And reimbursement Deck (11):
1

Capitation

Paying a fixed fee per person to provide a range of health services
Paid before service

2

Medicaid

A federal program that is based on income and other circumstances

3

Network

A group of health care providers linked through a contract to provide health care services to
Its members

4

Plan limitations

Intended to control drug use and reduce drug costs

5

Prescription limitations

Maximum amount of medication that may be dispensed at one time

6

Drug benefit limitations

Dollar limit
A maximum amount that can be spent at one time on a prescription

7

Deductible

A predetermined amount of money that must be spent on prescriptions before copayment begins

8

Fixed copayment

A predetermined fixed or predetermined dollar amount per prescription filled

9

Percentage copayment

A predetermined fixed percentage of the cost of the prescription filled

10

Variable copayment

A variable or different payment based on the type of drug being dispensed

11

Pharmacy Benefit management company

Focuses on the pharmacy services provided under a health care plan