Aetna US Healthcare (Medicare HMO)
Aetna has been one of the leading providers of quality health insurance in the United States for the last 150 years. There dedication to providing families with safe, cost effective health insurance plans places this provider amongst the crème de la crème of customer service firms. They maintain their position as a leader in the health industry through the practice of these core values:
* Integrity.
* Quality service and value.
* Excellence and accountability.
* Employee engagement.
Aetna US Healthcare provides effective service and easy to understand information regarding the benefits involved with choosing one of their many, high quality health insurance plans. This is a smart choice when it comes to health insurance.
Available in certain areas of California, New Jersey, New York and Pennsylvania, the Golden Medicare is a managed care plan like an HMO. This plan doesn’t allow for as much flexibility as a fee-for-service plan, only offering coverage within an established network of doctors, specialists and hospitals. A PCP, or primary care physician, is selected. This PCP will have access to all your medical history and manage your care. To be eligible for Aetna US Healthcare's Golden Medicare plan you must, first and foremost, live in the designated area: you need to qualify for Medicare Part A, and enrolled in Medicare Part B. Aetna US Healthcare's Golden Choice plan allows for a little more flexibility. This is a Medicare + Choice plan with out of the network benefits. These benefits include: visit any licensed out-of-network physician, and pay applicable deductible and coinsurance, visit any in-network physician and pay applicable specialist copay, or visit your PCP and pay the applicable PCP copay.
Tuesday, November 23, 2010
Medicare physician fee schedule - Quick overview
Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:
* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.
Medicare Physician Fee Schedule Payment Rates
Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)
Medicare Physician Fee Schedule Payment Rates Formula
The Medicare PFS payment rates formula is shown below:
[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF
Medicare fee schedule download
covered services and their payment rates. Physicians’ services include the following:
* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.
Medicare Physician Fee Schedule Payment Rates
Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)
Medicare Physician Fee Schedule Payment Rates Formula
The Medicare PFS payment rates formula is shown below:
[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF
Medicare fee schedule download

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