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   RE: opportunity for imps Please respond?
 From: Michael Safran
 To: Member Forum
 Posted: 05-17-2017 10:00

It might be easier to put in proposal what IS included in Capitation, as opposed to what is not.  So less need (incentive) to use all the codes many of us have become adept at using to make a living.
In addition, there is now some incentive to primary care doctors to offer even more comprehensive care and provide some of the services that patients are referred to Urgent Care, Specialists, etc.

E/M:  99201-99205,  99211-99215
Preventative codes:  99381-99387,  99391-99397
Weight loss management,
depression screen
AWV  /  Welcome to medicare:
Hospital transition:
Home Health Care orders:
Waived labs:
Immunization admin
(I am sure there are other codes I have overlooked that are appropriately apart of capitation and some may disagree with.    Others may want to make additions to this list and add the actual codes.)

Anything / everything else is still FFS.  ie: 
GYN / Pap  - this is a difficult one.   Politically probably still better to reimburse for this.
laceration repair
minor fracture codes
I and D
meds, injectables
? All other CPT codes that do not start with 9****

NO copay / deductible at primary care.   Incentivizes  patients to start with primary care.   That should save CMS lots of money.


Michael S. MD
Original Message:
Sent: 05-17-2017 08:44
From: Kathy Saradarian
Subject: opportunity for imps Please respond?

I still think you should ask for more.?? Even so, it will be a cost savings for Medicare by a lot.?? But if they approve less you will never get more.
--  Kathy Saradarian, MD Solo since 2003 Always Private, Small Group since 1990 Practice Partner since 2003 Branchville, NJ

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