Configure Capitation and Capitated Plans

Capitation payments are not like other income. How should you configure the PCC billing system so you can enter and track capitation payments over time?

Read the steps below to learn how to create appropriate insurance groups, plans, and income accounts to record and track capitation.

For this example, we will create a new capitated insurance company, “INSCO Insurance” and configure it so we can post capitated payments to it.

Create the Insurance Groups, Plans, Fees, Payment Types, and Accounts to Record and Track Payments

In order to track payments, we will first create a number of items in PCC’s underlying tables. PCC Support will complete these steps for you, but you may find the instructions helpful if you are a Practice Management administrator and make updates to your PCC tables.

1. Create Two New Insurance Groups
   1. Open the Table Editor (ted) in Practice Management
   2. Open table #17, “Insurance Groups”
   3. Add Two New Insurance Groups:
      • INSCO Insurance
      • INSCO Insurance Cap Clearing
   4. Edit “Order” field with sequential order numbers. This will help the two groups appear together on various practice management reports.
2. Create New Insurance Plans
   1. Open table #3, “Insurance Plans”
   2. Add a new insurance: “INSCO Insurance Cap Clearing”. Make sure it uses the INSCO Insurance Cap Clearing group. This plan will be used to track payments.
   3. Add each new capitated plan with assistance from PCC Support’s billing specialists. These plans will appear as policies on patient accounts.
3. Create Capitation Fee and Payment
   1. Open table #6, “Procedures”
   2. Add a new procedure called “Capitated Fee”.
      • Give it an accounting type of Revenue – Non-service
      • Add it to the appropriate group for reporting purposes. You might consider creating a new procedure group to track capitation income.
   3. Open table #11, “Payment Types”
   4. Add a new payment type called “Capitation Check Payment”
      • Give it a type of Check
      • Allow it to be posted through Payment Posting (pam).
4. Add a New Account and Patient For Tracking Payments
   1. Create a new patient record. First name: INSCO Insurance, Last name: Cap Clearing.
   2. Add the insurance “INSCO Insurance Cap Clearing” to the patient’s policies.
   3. Create a new account record. First name: INSCO Insurance, Last name: Cap Clearing.
   4. Link the new patient to the new account.

Post Capitation Payments

In order to not deflate your A/R with a credit, you will post the Capitation Check adjustment procedure at the same time as you post the Capitation Check payment. The incoming check will pay off the adjustment procedure, creating no change in your A/R.

To learn how, read Post Capitation Checks, Incentive Payments, Interest Payments, Overpayments, and Withhold Payments, or watch the tutorial video.