decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Capitation / Capitation contract issues
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Article Overview
This article discusses the main issues to review before entering a capitated care contract. It is aimed at practices and billing staff evaluating managed care arrangements and focuses on contract terms, subscriber base considerations, stop-loss provisions, and the scope of covered services.
Why This Topic Matters
Capitation agreements can affect practice revenue, risk exposure, and administrative workload, so understanding the major contract points helps organizations evaluate whether an arrangement fits their needs.
What You Will Learn
- What factors to review before signing a capitated care contract
- How managed care plan characteristics can affect a practice
- Why stop-loss provisions matter in contract review
- What kinds of services may be addressed in the contract
Who Should Read This
- Physicians
- Medical practice administrators
- Coders
- Billing staff
- Practice managers
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