Pharmacy Billing And reimbursement

Question 1

Capitation

Answer 1

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

Question 2

Medicaid

Answer 2

A federal program that is based on income and other circumstances

Question 3

Network

Answer 3

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

Question 4

Plan limitations

Answer 4

Intended to control drug use and reduce drug costs

Question 5

Prescription limitations

Answer 5

Maximum amount of medication that may be dispensed at one time

Question 6

Drug benefit limitations

Answer 6

Dollar limit

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

Question 7

Deductible

Answer 7

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

Question 8

Fixed copayment

Answer 8

A predetermined fixed or predetermined dollar amount per prescription filled

Question 9

Percentage copayment

Answer 9

A predetermined fixed percentage of the cost of the prescription filled

Question 10

Variable copayment

Answer 10

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

Question 11

Pharmacy Benefit management company

Answer 11

Focuses on the pharmacy services provided under a health care plan