What Is A Capitation Agreement Medicare

For both options, reimbursement was provided in the form of monthly interim payments, based on Medicares` estimate of the cost of providing services to the plan to its Medicare members. For plans that chose the reimbursement option, the actual costs at the end of the contract period were calculated based on the cost reports submitted by the HBOs. For prepayment plans for group practice, previous repayments have been adapted to the plan to reflect eligible and reasonable costs. HMO`s risk choice option compared the actual cost of HMO with retroactively determined adjusted average per capita costs (AAPCC), which represented the federal government`s cost to participants if they had been in the pay-as-you-go system. .