capitated rate

capitated rate

A predetermined rate (the cap) at which insurance companies reimburse healthcare providers (US: doctors; UK: hospitals and NHS trusts) for rendered services.
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State lawmakers view Medicaid managed long-term care as a way to address the concerns over the increased enrollment and achieve budget stability over time through a capitated rate system.
Eleven states have tried some sort of managed care for the developmentally disabled, but the Kaiser report found that many of those states backed up to a more hybrid approach, known as Primary Care Case Management (PCCM), through which there is a capitated rate for the primary care physician, but specialists are paid a fee-for-service rate.
In "Projected Impacts of Adopting a Pharmacy Carve-In Approach Within Medicaid Capitation Programs," Lewin researchers reported that these states where prescription drugs are not part of the Medicaid capitated rate but instead are "carved-out" - paid separately through the traditional fee-for-service (FFS) program - could collectively save $11.
Under the managed care model, the organization will be paid a capitated rate to provide all Medicare-covered services to the beneficiary, including dialysis.
renegotiated their pharmacy contract to set a capitated rate for all Part A residents, complete with a drug formulary program, physician education and case-by-case utilization review - a renegotiation that was expedited, Mr.
If major shifting of care from services included under the capitated rate to non-covered services occurred, a positive UPMHP effect would be observed in these regressions.
For example, General Motors joins an HMO and asks for a capitated rate for employees.
A laboratory negotiating a capitated rate with an HMO-a flat fee per enrollee for all testing-will have to guard against test-volume projections that are based on outdated information.
This comprehensive comparison will provide facilities with valuable information to better control costs in a capitated rate environment.
Communications sent to providers indicate that effective March 1, 2010, Anthem Blue Cross will modify the current payment policy to an unreasonable capitated rate per visit.
As part of the transaction, the Company also provides the full range of ESRD services to a sub-population of its patients belonging to a managed care organization under a full-risk, globally capitated rate structure and manages the practice of 17 physicians, 12 of which are nephrologists.
Both plans negotiated a capitated rate with the state to provide nearly all Medi-Cal services to eligible persons in the county.