capitation


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Related to capitation: Capitation tax

capitation

 [kap″ĭ-ta´shun]
the annual fee paid to a health care practice by each participant in a health plan.

cap·i·ta·tion

(kap'i-tā'shun),
A system of medical reimbursement wherein the provider is paid an annual fee per covered patient by an insurer or other financial source, which aggregate fees are intended to reimburse all provided services.
[L.L. capitatio, fr. caput, head]]

capitation

/cap·i·ta·tion/ (kap″ĭ-ta´shun) the annual fee paid to a physician or group of physicians by each participant in a health plan.

capitation

(kăp′ĭ-tā′shən)
n.
1. A poll tax.
2. A payment or fee of a fixed amount per person, such as one remitted at regular intervals to a medical provider by a managed care organization for an enrolled patient.

cap′i·tate′ v.
cap′i·ta′tive adj.

capitation

a payment method for health care services. The physician, hospital, or other health care provider is paid a contracted rate for each member assigned, referred to as "per-member-per-month" rate, regardless of the number or nature of services provided. The contractual rates are usually adjusted for age, gender, illness, and regional differences.

capitation

Capitated payment Managed care
1. A method of payment for health services in which a physician or hospital are paid a fixed amount is paid per enrollee to cover a defined scope of services for a defined population set–aka covered lives for a defined period of time, regardless of actual number or nature services provided; capitation may be used by purchasers to pay health plans or by plans to pay providers;.
2. capitation payment is made on the basis of the number of members each month. See Bundling, Fee for service, HMO, Medicare risk contract, Per diem, PMPM, PPO, Rate setting. Cf Fee-for-service.

cap·i·ta·tion

(kap'i-tā'shŭn)
A system of medical reimbursement wherein the provider is paid an annual fee per covered patient by an insurer or other financial source; the aggregate fees are intended to reimburse all provided services.
See also: managed care
[L.L. capitatio, fr. caput, head]

cap·i·ta·tion

(kap'i-tā'shŭn)
A system of dental reimbursement wherein the health care provider is paid an annual fee per covered patient by an insurer or other financial source, which aggregate fees are intended to reimburse all provided services.
[L.L. capitatio, fr. caput, head]

capitation (kap´ətā´shən),

n 1. the practice of dentistry financed by a set fee per person per given period of time. A form of contracted dental care, usually by a corporation, institution, or other group.
2. a system by which the contracting dental professional, assuming the financial risk, is compensated at a fixed per capita rate, usually on specific, predetermined dental services as appropriate and necessary to eligible subscribers.
3. a dental benefits program in which a dental professional or dental professionals contract with the program's sponsor or administrator to provide all or most of the dental services covered under the program to subscribers in return for payment on a per capita basis.
capitation fee,
n a predetermined per-person charge made by the carrier for benefits available under an insurance plan.

capitation

the annual fee paid to a professional person of any sort as payment for providing services on a continuous basis. The fee paid is based on the number of animal participants in the scheme—the capitation fee.
References in periodicals archive ?
The MSHO capitation for institutionalized residents is comprised of the institutional Prepaid Medical Assistance Program (PMAP) rate.
For optimal use of these applications, interfaces from the core capitation system's membership eligibility and provider network files are required.
In the first few months as part of a managed care plan, physician groups receive capitation payments but will not yet have any bills submitted by outside third-party providers.
Costs included were those in the capitation rates that covered all Medicaid-eligible individuals for psychiatric inpatient care, specialty mental health outpatient services, and mental health services in nursing homes, but excluded the cost of pharmaceuticals.
If a PACE enrollee does eventually require permanent institutionalization in a nursing home, the PACE provider must fill this need from its capitation payment.
The capitation model doesn't work in an environment like we're in.
When implemented, a prospective risk-adjusted capitation rate is assigned to each health plan enrollee based on the ACG to which they were assigned from their prior diagnosis history.
Insurance providers are no longer interested or willing to offer capitation.
But if capitation is going to catch on in other markets in which it has not yet made a dent, it will have to transform itself.
Ethical guidelines for physician compensation based on capitation.
By giving doctors the money upfront in a process that's known in the industry as capitation, the doctors decide what's medically necessary while still within budget.
Defined as predetermined payment rates for service utilization, payment capitation bases reimbursement on measurements such as per diem, per enrollee, per procedure, and per admission (Landry & Cox, 1996).