Entering a Capitation Payment

Version 14.19

Overview

In order to post a capitation payment into OP, you must first create a Capitation Account (ie Patient Chart). Once the account is created, a charge must be created to post the payment against. The instruction below is to create one capitation account. However, if your practice receives capitation payment from several payers, you might prefer to create an account for each, naming the chart "Aetna Capitation", for example.

Create a Capitation Patient Chart

  1. In the Clinical, Practice Management, or Billing tab, click the Patient Chart button.
  2. Ensure you do not already have a Patient Chart created for Capitation by searching for the "patient".
  3. Click the +New Patient button.
  4. Enter in the following information required to create a new Patient Chart:
  • Patient Last Name: Payments
  • Patient First Name: Capitation

Tip: This is where you will want to decide if you're going to be creating a chart for each payer. If you are, enter the last name as Capitation and the first name as the payer name, so that the "patient's" name is displayed as Aetna Capitation.

  • Date of Birth: Enter a past date.
  • Gender: Unknown (or select any gender).
  • Address: Enter the practice's address.
  • Phone: Enter the practice's phone number.
  • Primary Provider: Select the practice owner or other provider.
  1. Click the Save button to save.
  2. Click Insurance in the Chart Navigation panel.
  3. Create a new insurance record for the "patient" by adding the payer that is making the capitation payment.

Create a Capitation Charge

  1. Navigate to the Capitation Patient Chart for which you received a payment.
  2. Click Charges in the Chart Navigation panel.
  3. Click New Claim.
  4. Enter the following information to create the capitation claim.
  • Rendering Provider: Select a provider from your staff list. 
  • Insurance or Self-pay: Generally there is not an insurance record associated with the Capitation Payment Account
  • Date: The system defaults to the current date. If necessary to backdate, click the drop-down menu to change to the desired date. 
  • ICD code: Any administration DX code is acceptable to use since there is no claim going out to a payer. However, for tracking purposes, you may want to create a new miscellaneous ICD code for the purpose of capitation.
  • CPT: Enter the numeric CPT Code or click the Ellipsis button to search for the code CAP for Capitation. If you do not have a CAP CPT code, it is recommended to create one for tracking purposes.
  • Click the Unit Charge field to enter the value of the Capitation Payment.
  1. Click the Save button.
  2. Once your capitation charge is entered, post the insurance's capitation payment to the charge that you just posted. Note: This is posted as an insurance payment for reporting and tracking purposes.
Version 14.10

Creating a Generic Patient Account

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

  1. Click the Register button .
  2. Click 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).
  • Gender: Unknown (or any gender).
  • Address: Enter any Address or if you wish the address of your office.
  • Phone: Enter any Phone Number or the phone number of the office.
  • Primary Provider: Click the Search field and enter a Provider.
  1. Click the Green Checkmark button to Save.  

Posting a Generic Cap Charge

  1. Click the Account button to open the Patient Account.
  2. Use the Patient Search box to locate the patient.
  3. Click the Charges  tab.
  4. Click the Claim button.
  5. The Add/ Edit Charges window is displayed. 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 is an insurance record associated with the Capitation Payment Account
  • Date: The system default is the current date. To backdate if necessary, click the drop-down menu 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 button 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 drop-down menu to select the Diagnosis Code.
  • Click the Unit Charge field and 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 is posted as an insurance payment for reporting and tracking purposes.