# Medicare Capitation question



## jessicat (Mar 25, 2009)

I'm new to billing and have a few questions about Medicare Capitation. In the last 6 months I've had Medicare deny payment on 4 visits due to a capitation agreement. The Dr. is upset that we've basically let 4 patients be seen for free and he wants me to find out which patients are affected by the capitation agreement.

As I understand it Medicare will only pay a certain amount to a practice each month. If we bill more than that amount they will deny the claims because of capitation. Do I have that right?

How can I find out how much our limit is?

How can I find out which Medicare plans are affected? Is it exclusive to Part A or B? Or does it include all Medicare plans?

Any and all information would be helpful. Thank you in advance.


----------



## shajuanda (Mar 25, 2009)

*sha1genesis@yahoo.com*

Have you tried to visit the CMS.gov link, I am not certain about the Medicare Guidelines, I have been in the OB department for the past 7 years and really don't come across to many Medicare Patients. I hope this helps


----------

