Study sets, textbooks, questions
Upgrade to remove ads
7276 Week 4 Reimbursement
Terms in this set (20)
As described in the community pharmacy case scenario, who is the third-party payer?
Pitt Street Health
Is Joe's Pharmacy required to have a contract with Pitt Street Health to be a provider in their network?
Pitt Street Health will have a "rate" that they reimburse Joe's Pharmacy for brand-name drugs. This rate is based on which list (benchmark) price?
Which list price (benchmark) measure did Joe's Pharmacy use to buy the 30 capsules of the single-source brand drug, Pharmastatin 20mg?
What do the letters "MAC" stand for?
maximum allowable cost
What are the two ways that Joe's Pharmacy will receive payment for the drug and the services they render?
- patient co-pay
- reimbursement from third-party health plan
Are hospitals reimbursed for drugs the same way as community pharmacies?
No, they generally receive a single payment for all non-physician services, including drugs, that they provide during an inpatient stay or, less commonly, each inpatient day (per diem).
Which type of reimbursement system, retrospective or prospective, pays hospitals a fixed fee for services?
Establishment of a MAC price allows payers to pay...
...the same price for a drug, no matter the manufacturer.
Pharmacies are reimbursed differently based on...
...the plan and the rates they negotiate with the payer.
If the member is on a _____ type plan, their payment is independent of the total reimbursement to the pharmacy.
If the member is on a _____ type plan, their payment is determined by the reimbursement to the pharmacy.
What is the basis for payment for most drugs covered under Medicare's medical benefit.
Average Sales Price (ASP)
**it replaced AWP
The most common payment benchmark is _____, but _____ is becoming the gold standard for drug reimbursement for office-administered drugs.
Reimbursement is the mechanism by which health care ____ compensate _____ for services and products.
three types of payers
- public third-party payers
- private third-party payers
programs administered through federal and state agencies
complex organizations that vary in structure and profit status
A PPS is a method of reimbursement in which Medicare payment is made based on a ______ amount.
the goal of a PPS
Sets with similar terms
Prescription Drug Insurance
List 4 Med Terms
HIM 2543 Healthcare Billing and Reimbursement: Ch 1
Sets found in the same folder
7276 Week 1 Social-Behavioral Pharmacy & Practice…
7276 Week 2 Intro to Drug Pricing
7276 Week 3 Drug Payment Methodologies
7276 Week 5 Drug Pricing Transactions
Other sets by this creator
7295 Week 1 PowerPoint
7290 Week 5
7290 Week 4
7290 Week 3