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.
Under the managed care model, the organization will be paid a capitated rate to provide all Medicare-covered services to the beneficiary, including dialysis.
For one thing, some HMOs that are paying physicians a capitated rate have not been collecting detailed patient encounter data, so their risk adjustments may be off.
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.
However, the same fiscal pressures that led RxCare to move its long-term care prescription program to an inadequate capitated rate will undoubtedly force the outpatient prescription program to capitation as well.
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an HMO-a flat fee per enrollee for all testing-will have to guard against test-volume projections that are based on outdated information.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.
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.