When you enter a charge for a capitated plan, you can post procedures for services rendered and automatically record a zero for capitated patients. This gives you accurate accounts receivables. MD office enters every fee at the contracted amount and subtracts the difference between the co-pay and the contracted fee. This lets you compare what you wrote off against what you were paid in capitation and incentives.

MDoffice handles capitated HMO and PPO plans with a minimum of clerical effort, maintaining eligibility and co-payments by plan and patient. It tracks capitation payments of the patients of multiple providers and alerts you before authorized money or visits are exhausted.

When you enter charges for a patient covered by a capitated plan, you can post services that you rendered and record a zero charges for that patient. By posting capitation charges without adding them to receivables, you track the value of capitated services without inflating your accounts receivable. Automatically creating write-offs of capitated charges makes your receivables much more accurate.

You can produce reports of all eligible capitated patients to show how many patients you have for each capitated plan. By dividing the number of patients in a particular plan by the total of your patients, you can get a percentage of the practice that is capitated and easily track capitation by provider and facility.

By having every fee entered at the contracted amount and letting MDoffice automatically write off the difference between the co-pay and contracted fee, you can compare what was written off against what has been actually paid in capitation and incentive payments. If you want, MDoffice will make automatic capitation adjustments on normal fees.

Each time a patient using a capitated plan visits your office, the steps for that visit are identical to the steps for a normal patient visit. You enter managed care claims the same way as any other claim, but if there is a co-payment required with the insurance plan, co-payment comes directly from the patient's primary insurance plan.

If your office charges a total of $60 with a $10 co-payment, you enter a $60 cap, for procedures and a $10 patient co-payment. If the patient comes up with the $10, MDoffice will subtract $50 and mark the claim paid, otherwise will list the $10 as "Bill to Patient.

You can post capitation payments by membership, age and sex. By comparing the capitation payments received against payments expected, you can verify that you’ve been paid correctly. MDoffice can analyze capitation versus other methods of payment, and you can track payments by member count and see how they’re distributed across multiple physicians.

MDoffice maintains an up-to-date list of each plan’s members. The software tracks the membership ID number, start date, and termination date for each member as well as any comments. This master roster of all managed members contains historical eligibility detail. The Capitation Distribution Report lists members by their eligibility and the associated capitation information, broken down by plan and grouped by PCP. The report also shows member counts, including deletions.

To help you monitor your success with capitated contracts, MDoffice's capitated reports show actual services for charges for capitated patients and what you would have received on a fee for service basis. Managed care reports allow you to compare capitated payments against standard charges and other methods of payment. Other reports show patients whose authorizations need to be renewed for additional services.

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Contract Management

Intelligent capitated billing.