Stream: financial
Topic: fee-for-service claims VS capitated encounters
Varvara (Sep 17 2019 at 14:01):
Hello, @Paul Knapp is there any discussion around how to specify claim/EOB type as fee-for-service claim or capitated encounter (value-based healthcare concept) in FHIR resources? May we extend .use for that (adding use = encounter)?
Paul Knapp (Sep 26 2019 at 00:11):
Why would that be a different use, wouldn't you simply be supplying a Capitation billing code (e.g. 1 month of care) rather than a fee for service billing code (code for specific service performed or product provided)?
Varvara (Nov 28 2019 at 14:42):
@Paul Knapp I didn't know there are special billing codes for capitated services. as far as I see from adjudicated claims data, payers send usual billing codes with two kinds of indicators: capitated facility claim indicator and capitated service indicator.
Last updated: Apr 12 2022 at 19:14 UTC
