Capitated Product Benefits

Below is a brief description of how Capitated Plans work. For more information, contact Rajendra Bansal, MD or Jarred Kobert, BHS CRC. 

 

                1.  Medicare Fee For Service (MFFS)

Yields between $20.00 to $30.00 PMPM (per member per month)

How do we confirm this?

              A.)  Check the total amount you received from Medicare last year including reimbursement from visits, ancillaries, hospitals, and nursing homes.

              B.)  Check how many Medicare patients you have in the practice;  (number of patients + net visits) :  Any Medicare patients you have seen in the last two  years.

Divide A / B - That is your year per patient revenue.

Divide by twelve for monthly per patient revenue.

                2.  If you are a member of an ACO, you may be able to make $0.00 to $10.00  PMPM.

                3.  The total from Medicare may be $20.00 - $40.00 PMPM.

                4.  Humana will start you at $60.00 to $100.00 PMPM (double), depending on the number of lives and the medical expense ratio.  It may go up to $100.00 + PMPM.

 

What are other advantages to capitation?

1.  If you are on vacation, you are still getting paid.

2.  Natural calamities, you are still getting paid.

3.  Increased Sale price.