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Kareo Help Center

Capitated Accounts

Updated: 01/14/2022
Views: 2619

Under a capitated insurance contract, the provider is paid a pre-established amount that is not contingent upon the type of procedures performed; rather the procedure is performed on a patient who is insured under a capitated insurance plan. Kareo supports billing for providers who perform procedures under capitated insurance contracts.

To apply a payment or a portion of a payment to a capitated account, you must first create a capitated account if one has not already been set up. Once the account is created, you can select the payment that is associated with the account and apply payment.

You always begin with finding the capitated account before creating, editing, or deleting a capitated account. 

Find Capitated Account

  • Click Encounters > Find Capitated Accounts. The Find Capitated Account window opens.
    Tip_Icon.pngTip: When there are numerous capitated accounts listed, use the Look For search box to enter all or part of a keyword for the capitated account. Then, click Find Now
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New Capitated Account

  1. To prevent duplication, verify the capitated account is not in the system then click New at the bottom. The New Capitated Account window opens.
  2. Enter the information.
    • Name: The name for the capitated account.
    • Memo: Note or brief description related to the capitated account.
  3. Click Add. The Select Payment window opens. If applicable, select the All tab. Then, search and double click the appropriate payment with the unapplied capitated balance. The New Capitated Account window returns with the payment listed. Repeat this step as necessary.
    • To remove a payment added in error to the new capitated account, click once to select the listed payment in the New Capitated Account window then click Delete.
Desktop_CapAcct_New1.png
  1. Under the Capitated Amount column, enter the amount of the payment that is capitated.
  2. Click Save. The Find Capitated Account window returns with the new capitated account listed.
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Edit Capitated Account

  1. Find the capitated account then double click to open it. The Edit Capitated Account window opens. 
  2. Do the following as necessary.
    • Make the appropriate changes to the capitated account name and/or memo. 
    • Add payment(s) to the capitated account.
    • To remove a payment from the capitated account, click once to select the listed payment then click Delete.
      Note: Once deleted, any capitated amount that was applied from the associated payment record will be unapplied again.
  3. When finished, click Save.
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Add Payment to Capitated Account

  1. Find the capitated account then double click to open. The Edit Capitated Account window opens. 
  2. Click Add. The Select Payment window opens. If applicable, select the All tab. Then, search and double click the appropriate payment with the unapplied capitated balance. The Edit Capitated Account window returns with the payment listed. Repeat this step as necessary.
  3. Under the Capitated Amount column, enter the amount of the payment that is capitated.
  4. When finished, click Save
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Delete Capitated Account

Note: Once a capitated account is deleted, all capitated amounts applied from the associated payment records will be unapplied again. 

  1. Find the capitated account then click once to select it > Delete. A confirmation pop-up appears.
  2. Click Yes to confirm the deletion. The capitated account is deleted.
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