Category Archives: Risk Adjustment (MRA)
Capitation
The simplest definition of capitation is a per-member, per month (PMPM) payment based on a defined population of enrolled members; the payment has nothing to do with the level or amount of care given to the patient. In fact, when … Read Full Post
Fee-for Service (FFS) Reimbursement
Under FFS reimbursement, a physician’s revenue is based on CPT-4 and HCPCS coding, with each CPT-4 and HCPCS code assigned a specific reimbursement amount by the Centers for Medicare and Medicaid Services (CMS). Some managed care plans will discount their … Read Full Post
How does provider reimbursement work?
There are two common methods of reimbursing physicians: Fee-for- service (FFS) and capitation. There are also two major code categories in use by most primary care physicians: ICD-9-CM codes and CPT-4/HCPCS codes. ICD-9-CM codes (soon to be replaced by ICD-10 … Read Full Post
What is MRA?
MRA – Medicare Risk Adjustment – was established in 2003 and phased in over a five year period. Through this payment methodology, the MedicareAdvantage Plan’s (and the provider’s) capitation is adjusted based on the risk assumed for the patient’s care, … Read Full Post