Thursday, November 18, 2010

difference between Medicare and Medicaid insurance

What is the difference between Medicare and Medicaid?

While Medicaid and Medicare sound similar, they are in fact very different programs. One of the biggest differences is Medicaid is a state governed program and Medicare is a federal governed program. Here are some other differences:

Medicaid is for low income:
     Pregnant women
     Children under the age of 19
     People 65 and over
     People who are blind
     People who are disabled
     People who need nursing home care
Application for Medicaid is at the State's Medicaid agency.

Medicare is for:

     People 65 and over
     People of any age who have kidney failure or long term kidney disease
     People who are permanently disabled and cannot work
Medicare is applied for at the local Social Security office.
Some people qualify for both Medicaid and Medicare, Medicaid is sometimes used to help pay for Medicare premiums. People who qualify for both programs are called 'dual eligible'.

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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