Aetna Assessments: Practice Questions (2024) (2024)

FAQs

Which of the following are the core of all our product offerings for 2024 Aetna? ›

All 2024 Aetna Medicare Eagle plans will feature a $0 monthly plan premium, $0 primary care copay (including walk-in clinics), dental, vision, hearing, OTC allowance and a SilverSneakers fitness benefit. These plans also offer $0 copays for labs, colonoscopies and routine eye and hearing exams.

Aetna applies multiple procedure reductions to certain therapy services. The insurer will pay 100% of the therapy service the highest practice expense (PE) RVU. Aetna reduces the PE RVU portion of the total RVU by 50% for more therapy services performed on the same day.

Mutually Exclusive Edits: Mutually Exclusive NCCI edits prevent separate reimbursem*nt for procedures that could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations.

There are three ways to verify your ready-to-sell status. You must verify with us that you're "ready to sell." You can view your ready to sell status using our interactive map on Producer World or you can contact your recruiter or Aetna Medicare Broker Services.

Claim Filing Limits For Aetna

For non-participating providers, Aetna's standard claim filing deadline is 180 days from the date of service.

Tier 1 – Aetna® Premier Care Network Plus Multi-Tier providers. Utilizing a provider from this tier results in maximum savings for Aetna members. Tier 2 – Aetna Health broad network providers. Utilizing a provider from this tier results in standard savings for Aetna® members.

Modifier 51 is defined as multiple surgeries/procedures. Multiple surgeries performed on the same day, during the same surgical session. Diagnostic Imaging Services subject to the Multiple Procedure Payment Reduction that are provided on the same day, during the same session by the same provider.

Modifier 26 is appended to billed codes to indicate that only the professional component of a service/procedure has been provided. It is generally billed by a physician. Services with a value of “1” or “6” in the PC/TC Indicator field of the National Physician Fee Schedule may be billed with modifier 26.

What Is the Multiple Procedure Payment Reduction? MPPR is a per-day Centers for Medicare and Medicaid Services reimbursem*nt policy that applies across disciplines and across different practice settings. Imaging MPPRs apply to multiple diagnostic imaging services administered to the same patient on a single day.

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circ*mstances.

Does Aetna require a CQ modifier? ›

Aetna will require the use of the CO and CQ modifiers to signify services furnished in whole or in part by an OTA (use the CO modifier) or a PTA (use the CQ modifier). This Billing Reduction change was first adopted by Medicare in 2022 which was required by law through the 2018 Bipartisan Budget Act.

What is the main difference between the HMO-EPO plan and the PPO plan? The HMO-EPO plan only provides in-network coverage for services, except for urgent and emergent care which would be covered the same out-of-network as it would in-network. The PPO plan offers both in-network and out-of-network coverage.

A point-of-service (POS) plan lets you visit network and out-of-network doctors and hospitals. It's your choice. Page 2. Health insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna). A health insurance plan designed to give you choices.

The payer denied 93 percent of the emergency room claims that California investigated, underscoring that surprise billing remains a relevant issue during the coronavirus pandemic. Aetna has been fined by California's Department of Managed Health Care for denying emergency room claims against the state's standards.

Medical Clinical Policy Bulletins (CPBs) detail the services and procedures we consider medically necessary, cosmetic, or experimental and unproven. They help us decide what we will and will not cover. CPBs are based on: Peer-reviewed, published medical journals.

In 2024, the fitness reimbursem*nt benefit provides Aetna Medicare members in certain plans the ability to get reimbursed for fitness and activity fees and select supplies. This exciting benefit is in addition to the SilverSneakers® fitness benefit available with all Aetna Medicare plans.

In this case, Aetna Medicare DSNP expanded its services into the state of Virginia in 2024.

The annual deductible for all Medicare Part B enrollees in 2024 will be $240, an increase of $14 from the 2023 deductible of $226.

(/ˈɛtnə/ ET-nə) is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit ...