Entering a Capitation Payment

Version 14.8

Creating a Generic Patient Account

When entering in a Capitation payments into Office Practicum, you will want to create a Generic "Patient" account called Capitation Payments. Then as Capitation Payments come into the practice for Office Practicum claims, the end user will want to create a Capitation charge to that Generic Account and then pay the balance in full.

  1. Click on Register .
  2. Click in the patient search field .
  3. Click on +New Patient button.
  4. Enter in the following information highlighted in red:
  • Patient Last Name: Payments.
  • Patient First Name: Capitation.
  • Date of Birth: 01/01/2016 (or any date that you wish).
  • Gender: Unknown (or any gender that you wish).
  • Address: Enter in any address or if you wish the address of your office.
  • Phone: Enter in any phone number or the phone number of the office.
  • Primary Provider: Click on the search field and enter in one of your providers.
  1. Green Checkmark to Save.  

Post a Generic Cap Charge

  1. Click the Account button to open the Patient Account.
  2. If needed use the Search box  to locate the patient.
  3. Click the Charges  tab.
  4. Click the Claim button.
  5. The Add/ Edit Charges window will open. From here, enter the follow information noting that an item highlighted in RED is a mandatory field that must be filled out.
  • Rendering Provider: Select a provider from your staff list. 
  • Insurance or Self-pay: Generally there will not be an insurance record associated with the Capitation Payment Account
  • Date: The system default is the current date. To backdate if necessary, click the dropdown arrow to change to the desired date. 
  • ICD code: Click the Green Plus sign and enter the numeric code or description to search under the ICD Desc field. Then click the green checkmark to save the diagnosis code. Any DX code is acceptable to use, there is no claim going out to a payer. You may create a new miscellaneous ICD code for the purpose of capitation if you wish.
  • CPT: Enter the numeric CPT code or click the Ellipsis button to search for the code CAP for Capitation. 

If a capitation CPT code is not added to your system please see: Adding in CPT codes
  • Diagnosis codes must be assigned to each CPT code line. Use the dropdown to select the diagnosis code.
  • Click in the Unit Charge field to enter the value of the Capitation Payment.
  • Click the green checkmark button to save.
  1. Once all charges have been entered click on the save button in the bottom right hand of the Add/Edit Charges screen.
  2. Once your capitation charge is entered, post the insurance's capitation payment to the charge that you just posted. Note: This will be posted as an insurance payment for reporting and tracking purposes.