Wiki TTL for Capitation and fee for service

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Blackhorse

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We have patients under Prospect insurance paid by Capitation and fee for service. How do we figure out how much we got paid from fee for service claims each month? Right now, I have to open up each claim and see if it's paid under Cap or FFS which is very time consuming. Is there a quick way to know the total amount for FFS claims each month?
 
Well, since only certain CPT codes are paid as capitation, wouldn't you run a report based on insurance plus CPT codes? Is there a "type" or other field you can use for each CPT code to show that it is capitated, so you can run a report on insurance plus CPT type?

What software do you use?
 
I'm running a report for 99214 because that's the code we use a lot here. We are pain management, I think maybe I can run 64483, 64484, 64493, 64494, 62321, 64633, 64634, 64635?
 
Have you read the ECW billing guide here?: http://71.14.243.179/Customer_Manuals/Old/BillingUsersGuide_070207.pdf

It looks like it gives you a comprehensive step-by-step guide to handling capitation, and if you set up the insurance correctly, enter a capitation charge correctly, and post the capitation payment correctly with the right adjustment code, then running the report should be simple. The Daily Financial Summary might be the report you're looking for, and it can be run for a range of dates (not just one day).
 
SharonCollachi said:
Have you read the ECW billing guide here?: http://71.14.243.179/Customer_Manuals/Old/BillingUsersGuide_070207.pdf

It looks like it gives you a comprehensive step-by-step guide to handling capitation, and if you set up the insurance correctly, enter a capitation charge correctly, and post the capitation payment correctly with the right adjustment code, then running the report should be simple. The Daily Financial Summary might be the report you're looking for, and it can be run for a range of dates (not just one day).
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Thank you. Currently we need to find out the total for FFS PT. Nobody knows how to run a report to get the total payment for FFS PT. We have to open up each claim to see how much was paid.
 
FFS = Total minus capitation

Again, this is all related to the way you set up your capitation. If you get one capitation check per month, then just subtract that one check from the total.

You shouldn't have to open any claims - did you look at the manual?
 
SharonCollachi said:
FFS = Total minus capitation

Again, this is all related to the way you set up your capitation. If you get one capitation check per month, then just subtract that one check from the total.

You shouldn't have to open any claims - did you look at the manual?
Click to expand...
We have a third party billing company process our billing, I'll check with them to see how they set up the capitation. I understand your thought process now, thank you so much.
 
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