|2721 Capital Ave.
Sacramento, CA 95816-6004
Phone: (916) 446-5054
Message: (561) 873-8335
Fax: (916) 446-0500
|American Society of Dermatology, Inc.
A Voice for Private Dermatologists Since 1992
BASIC REIMBURSEMENT OPTIONS
There are two basic compensation methods offered under
managed care plans.
Compensation for services is based either on a fee-for-service discount of 10 to 25 percent or a specified fee schedule.
Under a fee schedule, fees for each service are based on an average prevailing rate or a resource-based relative value scale (RVS) and are discounted by a specified percentage. Additional compensation may come from copayments or deductibles.
This payment arrangement ensures a fixed amount of compensation based on the number of people covered by the insurance plan calculated on a per member per month (PMPM) basis. Compensation is not based on the number of patients seen or individual services performed.
As discussed later, capitation plans are generally riskier than fee-for-service plans for dermatologists if not negotiated effectively.