Practice Management Alert

Reader Questions:

Get to Know Capitation Contracts

Question: I'm confused about what capitation actually is and how we bill under capitation rules. Can you explain?State SubscriberAnswer: Capitation is a reimbursement method in which the payer reimburses the provider a fixed amount per month for every member of the health plan panel to whom they provide some type of service. The payer reimburses you at set intervals throughout the year -- monthly, quarterly, semiannually, or annually -- as set up in a capitation contract.Under capitation the contracted payer reimburses you based on the number of patients covered in the contract (by head) rather than by the number of services your physician provides. You get the same amount whether you see a patient once or 20 times.Under capitation, you have to track services for the panel and will probably have to submit claims, even though the payer won't pay you on a per-claim basis. There will likely also be services that are [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Practice Management Alert

View All