The hidden risks and subtleties of capitation or, what you were never told when you agreed to accept capitated risk.
For your physician practice to be successful under a capitated contract, you must understand the subtleties of the arrangement that can impact the practice's level of risk exposure. This means you must know the key questions to ask when negotiating the contract and capitation amount, as well as what should be monitored to ensure the contract is implemented correctly. How the capitated rate is calculated and whether or not it appropriately covers the risk of each benefit plan the practice will be servicing will determine the financial viability of the contractual agreement. In addition, after the contract becomes effective, you should make sure that the practice is providing and billing for services consistent with its contractual obligations, and that the reimbursement received is correct based on the practice's membership mix.
Prescott
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First Health, Ann Arbor, MI, USA.
D002204:Capitation Fee; D004608:Eligibility Determination; D006123:Group Practice / Q000191:economics*; D006264:Health Benefit Plans, Employee / Q000191:economics; D006279:Health Maintenance Organizations / Q000191:economics; D007344:Insurance Claim Reporting; D017008:Negotiating; D011907:Rate Setting and Review; D012308:Risk Management; D014481:United States