Saturday Quiz

Designed to Enlighten and Amaze

 

In general, how long does it take for a submitted risk code to begin to affect your monthly capitation rate?

A. Immediately

B. One-to-two months

C. Three-to-six months

D. Six-to-twelve months

E. Twelve-to-eighteen months.

 

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The shocking answer below.

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The answer is D. Six-to-twelve months

The length of time can vary slightly, but think of it this way.

Imagine the six months from January to June and from July to December each as individual six-month blocks. Any code you submit anytime within those blocks will be officially “accepted” by CMS on the last day of that block. There is then a one “block” “waiting” period where CMS has the code, but it doesn’t affect the capitation rate.

At the beginning of every “block” CMS reconfigures your capitation rate based on the previously submitted diagnostic data. After the one “block” waiting period, the risk code you submitted will affect the capitation rate for the next two “blocks,” then it drops off.

Confusing?  All you really need to know is this:

If you consistently submit your patient’s risk codes every calendar year, you can be assured there won’t be a “block” where they are not reflected in your patient’s capitation rate.

That’s a much simpler way to understand the system—but at least now you understand the reasoning behind the recommendation.