OVERPAYMENT BY CAPITATED PLAN

DESCRIPTION OF THE ISSUE

Dr. was capitated with insurance for office visits.  In such case we received both Capitated as well as Fee-for-service payments for office visits for an amount of $18K.

CONCEPT

Being capitated plan for office services under PUP, we are not supposed to receive fee-for-service payments for the same.

SOLUTION

On identification of this issue, PUP insisted on off-set for the overpaid value in the future payments.  But we raised a request towards Dr’s office to issue refund in bulk in order to avoid off-set in future payments.  Both PUP and Dr’s office agreed for the same.