Medical Billing Forum

Payments => Insurance Payments => Topic started by: pvtbiller on March 17, 2012, 07:36:43 AM

Title: Cappitated Payments
Post by: pvtbiller on March 17, 2012, 07:36:43 AM
Can someone please explain to me what cappitated payments are and what us covered under them?  Would dme be under a cappitated plan for a doc or bu because dme is medicare part b always?  Thanks for your help
Title: Re: Cappitated Payments
Post by: AZbiller on May 10, 2012, 11:53:18 AM
Hi. I'm not sure what state you're in and I'm not sure if capitated plans are different from state to state. But I'm in Arizona and we see a handful of capitated insured patients. We receive a set payment from the insurance plan per month regardless of whether the patient is seen or not. The patient is only responsible for their copay. If the patient is seen for other that just an office visit, such as a procedure or injections, that is reimbursed at the contracted rate.

Hope this helps.
Title: Re: Cappitated Payments
Post by: PMRNC on May 10, 2012, 02:04:35 PM
It's not state dependent, but rather carrier specific. Each carrier/plan that has capitation has their own way of doing it. For example, some require a billing statement each month and some don't. Best thing to do is to look at the contract as it will have their procedures in there, if in doubt, call them.