Tuesday, November 23, 2010

Medicaid eligibility requirements and covered service

Medicaid

Like Medicare, A Medicaid plan is a Federal health insurance program that provides much needed care for select low-income families. The plan offers health insurance to such people as the disabled, the blind, the aged, and select families with dependent children. Although a Federal program, a Medicaid plan is run by the individual states, allowing for discrepancies amongst whom is eligible, and the extent of the services provided within the resepctive plan. Look below for more information:


Eligibility Requisites:


    * Qualify for the Aid to Families with Dependent Children (AFDC) program.
    * Children under the age of 6 whose family income is at or below 133% of the Federal Poverty Level. (FPL)
    * Pregnant women at or below 133% of the FPL.
    * Most States' Supplemental Security Income (SSI) recipients.
    * Recipients of adoption or foster care assistance.
    * Children under the age of 19 who have incomes below the FPL.

Services Provided by Medicaid plan:

    * Inpatient & outpatient hospital services.
    * Prenatal care.
    * Vaccines for children.
    * Physician services.
    * 21 and older nursing facility services.
    * Family planning services.
    * Rural health clinic services.
    * Home health care for persons eligible for skilled-nursing services.
    * Lab & X-ray services.
    * Pediatric and family nurse practitioner services.
    * Nurse-midwife services.
    * Screening, diagnostic & treatment services for children under 21.

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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