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Thread: Medicare Capitation question

  1. #1

    Default Medicare Capitation question

    AAPC: Back to School
    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
    Join Date
    Apr 2007

    Default sha1genesis@yahoo.com

    Have you tried to visit the CMS.gov 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

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