2721 Capital Ave.
Sacramento, CA 95816-6004
Phone: (916) 446-5054
Message: (561) 873-8335
Fax: (916) 446-0500
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American Society of Dermatology, Inc.
A Voice for Private Dermatologists Since 1992
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NEGOTIATE SPECIFIC REFERRAL GUIDELINES
Unless you establish clear referral guidelines, a sudden flood of capitated patients could overwhelm your practice. 9
- Base referral guidelines on specific CPT and ICD-9 codes negotiated in the contract. Providing a clear set of referral guidelines under a capitation agreement sets a standard for the PCPs to follow. Services that are not referred under the capitation agreement should be specified by CPT code and negotiated on a fee-for-service basis.
- Set specific guidelines for increasing compensation when referral rates increase. Negotiate in 10 percent increments. If your referral rate increases or decreases by 10 percent, it should be matched by a 10 percent increase or decrease in your capitation rate.
Attaching these guidelines to your contract puts in place a mechanism to control patient flow and gives you leverage should misuse of these standards occur.
9 The Appendix contains sample guidelines you could use as a basis for your own guidelines. You will need to modify the sample guidelines so that they are appropriate for your capitation contract.
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