Financial Terms
To check the accuracy of financial accounts and records.
What does audit mean?
The sharing of expenses by the policyholder and the insurance company.
What is coinsurance?
Average price at which drugs are purchased at the wholesale level.
What does AWP or average wholesale price mean?
A complete list of items such as property, goods in stock, or the contents of a building.
What is inventory?
A practice that occurs when a patient is paid cash by an individual to illegally purchase pseudoephedrine from more than one pharmacy.
What is smurfing?
Net sales minus the cost of goods sold.
What does gross profit?
The portion of the cost of a prescription that the patient is responsible for paying when a part of the cost is covered by a third-party payer.
What is copayment or copay?
A United States federal-government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries.
What is medicare—Part D Prescription Drug Coverage?
The total value of the entire stock of products on hand for sale on a given day.
What is inventory value?
Medicare Part D coverage gap.
What is a donut hole?
The difference between the purchase price and the selling price; also called gross profit.
What does markup mean?
Amount of money on must pay before they begin receiving any benefits from the insurance company.
What does deductible mean?
A formulary provided by an insurance company that indicates preferred prescription generic and brand-name drugs and their corresponding co-pays.
What is a preferred drug list?
A record that tracks the quantity of, and cost assigned to, inventory items as they are purchased and sold.
What is Perpetual Inventory Record?
Real-time insurance claims processing via wireless telecommunications.
What is online adjudication?
Transferring information from a journal entry to a ledger account.
What does posting mean?
Insurance coverage in which a patient pays one co-pay for brand-name drugs and a lower co-pay for generic drugs.
What does dual copay mean?
Approval for coverage of a high-cost medication or a medication not on the insurer's approved formulary.
What is PA or prior authorization?
Purchasing items as needed or "just in time."
What is JIT (Just-In-Time) Purchasing?
A federal and state assistance program that pays for health care services for people who cannot afford them.
What is Medicaid?
The amount of time the average drug inventory will be replaced during a 12-month period.
What is inventory turnover rate?
The process to determine the responsibilities of multiple insurance policies.
What does COB or coordination of benefits mean?
A third-party administrator of prescription drug programs.
PBM (Pharmacy Benefit Manager)?
Equipment such as wheelchairs or hospital beds meant for long-term use.
What is DME (Durable Medical Equipment)?
Consumable, disposable items that can only be used by one patient for a specific purpose.
What is Nondurable Medical Supplies?