Results 1 to 2 of 2

Medicare Capitation question

  1. Default Medicare Capitation question
    Medical Coding Books
    I'm new to billing and have a few questions about Medicare Capitation. In the last 6 months I've had Medicare deny payment on 4 visits due to a capitation agreement. The Dr. is upset that we've basically let 4 patients be seen for free and he wants me to find out which patients are affected by the capitation agreement.

    As I understand it Medicare will only pay a certain amount to a practice each month. If we bill more than that amount they will deny the claims because of capitation. Do I have that right?

    How can I find out how much our limit is?

    How can I find out which Medicare plans are affected? Is it exclusive to Part A or B? Or does it include all Medicare plans?

    Any and all information would be helpful. Thank you in advance.

  2. #2
    Have you tried to visit the link, I am not certain about the Medicare Guidelines, I have been in the OB department for the past 7 years and really don't come across to many Medicare Patients. I hope this helps

Similar Threads

  1. Dialysis-Monthly Capitation Payment Medicare
    By bethb in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 11-24-2015, 02:25 PM
  2. Monthly capitation
    By in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 04-22-2015, 01:34 PM
  3. capitation payments
    By emason in forum Billing/Reimbursement
    Replies: 2
    Last Post: 02-08-2013, 12:31 PM
  4. Capitation
    By labackus4 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-30-2011, 03:08 PM

Tags for this Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.