decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Capitation / Capitation case study
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Article Overview
This article uses a capitation case study to show how an anesthesia group’s monthly payment arrangement is set up, monitored, and reviewed over a contract year. It is aimed at readers who need to understand the general business and billing workflow behind capitation agreements, including how reports are used to monitor performance and support later contract discussions.
Why This Topic Matters
Capitation arrangements can affect cash flow, billing workflow, and year-end reconciliation. This example helps readers understand the operational side of managing such an agreement in a physician practice setting.
Article Sections
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Case study overview
Introduces the anesthesia practice example and the basic capitation arrangement being used for the discussion.
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Contract terms and payment setup
Describes the general structure of the agreement, the monthly payment approach, and the service categories included in the arrangement.
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Billing workflow and monthly tracking
Explains how charges are entered, how reports are generated, and how the practice monitors activity during the contract period.
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Year-end reconciliation and follow-up
Covers the end-of-year review process, the comparison of collected amounts to actual charges, and the contract follow-up discussion.
What You Will Learn
- How a capitation agreement may be structured in a physician practice setting
- How monthly payment and reporting workflows can be handled under capitation
- How year-end review and reconciliation may be approached
- How capitation results can inform later contract discussions
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle professionals
- Anesthesia practice administrators
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