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.
Mentioned in ?
References in periodicals archive ?
"Once the insurance company is paid its capitated rate by the state, it's up the insurance company how it's going to make money.
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.
The "capitated rate"--the amount the companies would get per person for medical services alone--could vary from as much as $175 for a healthy Medicaid recipient to some $1,165 for an adult with developmental disabilities.
Medicare's revised end stage renal disease (ESRD) prospective payment system (PPS) is designed to broaden the scope of services covered under the dialysis capitated rate, mitigate increases in expenditures, and improve patient quality of care.
When contracted services were used, 29 percent of the reporting systems based their payments on a capitated rate.
Thus, payments will be 21.5 percent of the risk-adjusted capitated rate when Medicare (i.e., the MA plan) is secondary.
Under the managed care model, the organization will be paid a capitated rate to provide all Medicare-covered services to the beneficiary, including dialysis.
Some providers appear to have a strategy of recouping budgetary shortfalls by (a) selling employers a collateral product (such as coaching, training, or critical incident intervention) with a higher profit margin, (b) attempting to increase market share, or (c) tightly managing costs by providing fewer services within the capitated rate structure.
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.
Given the reputation of HMOs for skimping on medical care, some children's advocates object to the capitated rate for child-welfare services.