The topics discussed in this section include...
- A. The patient has a capitated office visit and no “billable” services
- B. A capitated patient has several procedures
A. The patient has a capitated office visit and no “billable” services
PracticeMaker® has been programmed to help you adjust off that portion of an invoice that will not be paid because of capitation. You should still select your E&M code as if the patient was NOT capitated.
In order for the following scenario to work , the patient’s primary insurance MUST be set to capitation in the insurance module as show here.
You performed a 99214, which has your usual fee of $85. The patient’s copayment is $10.
· After you correctly posted the $10 copayment you will get the following dialog.
After clicking OK (same as pressing [enter]) an automatic capitation adjustment is created and the final payment section looks like this.
Another way to force PracticeMaker® to create a capitated adjustment is to click the
button. However, if the patient did NOT pay the copayment you will NOT be able to process a capitated adjustment by clicking this button. Instead of an adjustment you get the following dialog…
In this case either post the copayment OR wait until the patient pays then adjust.
B. A capitated patient has several procedures [top]
If there is more than one procedure on a capitated invoice, you will get this dialog before an adjustment is created.
If you click No, no adjustment is made now because you intend to bill for all or some of the services on this claim. After you have received payment a capitated adjustment will be created for you at that time. If you click Yes the remaining balance will be adjusted.
last updated 9/2/2004