Capitation Payments

 

Generate an Unpostables Worklist for capitation checks

1. Display the Find Unpostables page: On the Main Menu, click Financials. Under PAYMENTS, click Unpostables. In the left menu, under UNPOSTABLE REMITTANCE, click Find Unpostables.
   The Find Unpostables page appears.
2. Unpostable status — Select OPEN.
3. Unpostable type — Select Capitation Payment.
4. Click Generate Worklist.
   The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

5. From the worklist in the Task Bar, click the Capitation Payment bar to expand the worklist.
6. Click the linked unpostable ID number for the first capitation remittance record/unpostable in the worklist.
   The Remittance Record page appears in the Workspace.

Enter the capitation check information

7. Scroll down to the Capitation information field (under the Details heading) and click the Record Cap Check link.
   The Capitation Payments page appears in the Workspace, with the payment batch information at the top of the page.
8. Capitation contract — Select the capitation contract associated with the capitation payment.
9. Custom insurance group — Select the payer that issued the capitation check.
10. Check # — Enter the check number.
11. Notes — Enter any notes about this capitation check.
12. Payment Amount — Enter the amount of the capitation payment. A second payment row appears automatically. Typically, you need to fill out only the first row using the entire amount of the check, so you can ignore the new row.
    Note: In rare situations, you may need to split the capitation check into separate payments — for example, by individual providers. You can use the new row to accommodate this scenario. Each time you enter a payment amount, a new row appears. The sum of payments you enter must equal the amount of the check.
13. From Date and To Date fields — Enter the date of service range (required) covered by the capitation check. This selection must match the terms of your contract, so that you can accurately evaluate the contract.
14. Department — Select the service department covered by the capitation payment, if applicable. This selection must match the terms of your contract, so that you can accurately evaluate the contract.
15. Provider — Select the provider covered by the capitation check, if applicable. This selection must match the terms of your contract, so that you can accurately evaluate the contract.
16. When you are finished, click Save.
    Note: You are not required to balance the sum of the Out-of-Balance field.

1. Display the Capitation Payments page: On the Main Menu, click Financials. Under PAYMENTS, click Capitation Payments.
2. Locate the capitation payment in the list of payments that appears at the bottom of this page.
1. If the list is too long, you can use the filter fields at the top of the page to limit the list to payments that match your criteria.
2. Click Filter. The list of capitation payments that meet your criteria appears. The list is sorted in ascending order by ID number.
   
3. Click the [ capitation payment ID # ] link. The edit view of this page appears.
4. Edit the fields as needed.
5. Click Save. The updated capitation payment appears in the list.

 

Note: athenahealth will resolve Capitation Payment remittance records and close them as Recorded Capitation Payment. You can review these records on the Capitation Payments page.

1. Display the Find Unpostables page: On the Main Menu, click Financials. Under PAYMENTS, click Unpostables. In the left menu, under UNPOSTABLE REMITTANCE, click Find Unpostables.
   The Find Unpostables page appears.
   
2. Unpostable status — Select OPEN.
3. Unpostable type — Select Capitation Payment.
4. Click Generate Worklist.
   The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

5. From the worklist in the Task Bar, click the Capitation Payment bar to expand the worklist.
6. Click the linked unpostable ID number for the capitation remittance record/unpostable in the worklist.
   The Remittance Record page appears in the Workspace.

In the Status section

7. Under Select an action to resolve or reassign record, select the Update status and reassign record option.
8. Update status — Select Recorded Capitation Payment.
9. Click Submit.

 

You can reconcile the charges included in your monthly service invoice with the capitation payments posted in athenaOne using the Capitation Payments report in the Report Library.

1. Display the Report Library page: On the Main Menu, click Reports. Under General, click Report Library.
2. Click the Other tab.
3. Under Standard Reports, locate the Capitation Payments report.
4. Click run.
5. Post Date — Enter or select the date range for the report. This date range specifies the posting dates for the capitation payments.
6. View Type — Select the view of the report data. You can display a summary view of the data by practice, provider group, or provider, or you can display itemized details of the capitation payments.
7. Report Format — Select a report format.
• HTML table — Display the report results on your screen.
• Text (tab-delimited) — Export the report results to a .csv file in tab-delimited format.
• Text (comma-delimited) — Export the report results to a .csv file in comma-delimited format.
8. Report Options — Select (or deselect) any of these options:
• Suppress Column Headings — Select this option to remove column headings from the report results.
• Suppress Report Name — Select this option to remove the report name from the report results.
• Show Filter Criteria — Select this option to include your selected filter criteria in the report results.
• Run Offline (will appear in your Report Inbox tomorrow morning) — Select this option for very long reports. Reports that are run offline appear in your Report Inbox the morning after the request.
9. Click Run Report.

 

 

 

Capitation checks are recorded in athenaOne as remittance records/unpostable records, with an unpostable type of "Capitation Payment."

 

If your practice is an athenaCollector (No Posting) practice, follow the steps below to record your capitation checks. After you record a capitation payment, you can track and update the item using this page (click view/edit for the item).

 

 

To evaluate your capitation contracts, you need to know how your actual capitation payment amount compares with the amount that your practice would have received if the covered charges had been paid on a fee-for-service basis. You can compare these amounts for each contract, for each period of service (usually monthly).

 

To do this, you need to create capitation policies for each capitation contract used in your practice. Use the Capitation Wizard page to create capitation policies.

 

The Capitation Wizard utility runs nightly to identify any BILLED charges covered by your capitation policies (capitation contracts) and create automatic adjustments for those charges. You can then use the Capitation Payments page to evaluate each contract, for each period of service.

1. Display the Capitation Payments page: On the Main Menu, click Financials. Under PAYMENTS, click Capitation Payments.
2. Click the [ capitation payment ID # ] link for the capitation payment that you want to evaluate. The information appears in the fields at the top of the page.
3. Compare the Unpostable Amount (the amount of the capitation check) to the amount in the Cap adjustments covered under this check field (which contains the total amount of capitation adjustments — the amount that your practice would have received if the covered charges had been paid on a fee-for-service basis).  
   Because the amount of capitation adjustments can change over time (as new charges are entered and billed), the Capitation Payments page provides a Recalculate button. When you click the button, athenaOne recalculates activity of all capitation adjustments compared to charges covered by the capitation payment (e.g., for the date of service, payer, or provider, according to the capitation contract).

Note: The amount in the Cap adjustments covered under this check field will always be $0 if no capitation policy covers the capitation payment. Your practice should have both an allowable schedule and a capitation policy defined that covers the capitation payment's payer and procedure code. Refer to the Capitation Wizard page for more information about capitation policies.

See also: Allowable and Fee Schedules, and Allowable Schedules.

 

Note: If you record the amount in the Cap adjustments covered under this check field into a GL system, you may not want to Recalculate after you enter the amount into your GL, so that athenaOne matches the amount in your GL system.