Author Topic: Rate for capitated IPA patients  (Read 220 times)

ManDuong

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Rate for capitated IPA patients
« on: August 18, 2021, 04:51:13 AM »
Dear friends,

I am using a third party biller remotely and not sure how to pay for capitated IPA patients.

Do they get certain percentage of the total capitated monthly payment? They do need to submit encounters to healthplan/IPA for review but not for billing purpose.

Practice: internal medicine, private practice in California. 

Please help.  mancduong@gmail.com

Thank you.

RichardP

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Re: Rate for capitated IPA patients
« Reply #1 on: August 18, 2021, 02:16:00 PM »
We are in Southern California.  We bill for a scenario similar to yours.

In terms of data entry, we enter the same data into the Practice Management software that we would enter if we were billing a normal Health Insurance carrier.  This is for record-keeping in case anyone wants a history of patient visits, etc.  This record keeping cannot provide complete data on CPT codes used for the reason in the next paragraph.

We get paid 5% on office visits (usually 99212 / 3) and sometimes for EKG's (93000) only.  Any other work the provider does is noted on the fee slip, but we do not enter that into the Practice Management software and we do not get paid a percentage for that work.  We also do not send patient bills for this provider's capitated patients (he has a mix of capitated and non-capitated).

Because the provider is being paid a flat fee for seeing the capitated patients, regardless of what CPT codes he uses, he codes the office visits on the lower side - so as to pay us less money, regardless of the work done.  We generate enough revenue off of this provider to make it worth our while.  Your mileage may vary.

Medical Billing Forum

Re: Rate for capitated IPA patients
« Reply #1 on: August 18, 2021, 02:16:00 PM »