Capitation Fee in Medical Billing
A capitation fee is the fixed amount paid to a healthcare provider by an insurance company on a per-member, per-month basis for managing a patient’s care.
Capitation Fee in Medical Billing Explained
The capitation fee is a set monthly payment made by the insurer to the provider, regardless of how many services or treatments the patient uses. Providers are incentivized to keep patients healthy to avoid the need for expensive interventions, as they will not receive additional payments for providing more services.
For example, a healthcare provider is paid a capitation fee of $40 per month for each patient, whether the patient visits the clinic once or multiple times during that month.
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