Why is a DOFR used?

The Division of Financial Responsibility (DOFR) provides a required calculation currently used in the contracting process by health plans, physician organizations and hospitals to define which party is financially responsible for services rendered.

What is a global risk contract?

Global risk contracting is often used to describe the situation where a health plan enters into a. capitation agreement with only one health care provider to shift the entire risk for the provision of. both institutional and professional health care services to a single entity.

What does DOFR stand for?

A Division of Financial Responsibility (DOFR) is a provision in a contract between a health care provider and a health plan or payer that defines which party is financially responsible for providing specific services.

What is a DOFR in insurance?

Division of financial responsibility (DOFR): A tool used in the contracting process that describes whether it is the payer or the provider organization that is financially responsible for delivering a given service.

What does full-risk capitation mean?

Full-risk capitation arrangements involve shared financial risk among all participants and place providers at risk not only for their own financial performance, but also for the performance of other providers in the network.

What is full-risk Medicare?

Under the full-risk model, physician-management companies receive a monthly fixed payment from private Medicare Advantage plans, rather than payment for each patient visit. The fixed monthly payment covers various areas of care for beneficiaries, including drugs, physician services and hospital stays.

How does capitation work in healthcare?

Capitation is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. If the health plan does well financially, the money is paid to the physician; if the health plan does poorly, the money is kept to pay the deficit expenses.

What is an example of capitation?

A capitation example would be an IPA—a type of HMO—that has 5,000 patients. The IPA needs to secure insurance coverage for its patients for the upcoming year. Thus, it would enter into a capitation contract with a physician. The physician would be paid a fixed payment to treat all 5,000 patients.

What is the concept of capitation?

Who is the largest Medicare Advantage provider?

UnitedHealthcare. UnitedHealthcare is the largest managed care medical insurance provider in the world by revenue. Its 115 million customers annually generate $226.2 billion in revenue.

Who bears the risk in a capitated contract?

[7] The predetermined dollar amount is termed a “PMPM,” meaning “Per Member, Per Month.” The provider’s risk lies in the Member’s utilization of the health plan. Traditionally, providers such as physicians and physical therapists entered into capitated agreements for strategic reasons.

Who uses capitation?

Capitation payments are used by managed care organizations to control health care costs. Capitation payments control use of health care resources by putting the physician at financial risk for services provided to patients.

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What does Dofr stand for in health care?

The DOFR provides a framework for health plan and provider organizations when allocating financial responsibilities for services and includes a standard set of health care service categories and over 10,000 associated billing and revenue codes.

How is your division of financial responsibility ( Dofr ) doing?

How is Your DOFR Doing? 1 Purpose of DOFRs. A Division of Financial Responsibility (DOFR) is a provision in a contract between a health care provider and a health plan or payer that defines which party 2 Negotiating DOFR Changes. 3 Evaluating New Contracts. 4 Pitfalls to Avoid. 5 Conclusion.

How can I access the Dofr registration system?

To access the DOFR registration system, you need to be logged into your ICE website account, and once logged in, you will see the ‘Coded DOFR’ menu option where you will be able to request access to the document and download it if access is granted based on the availability limitation noted above.

Is the dofr a value added service for ice?

As a value-added service for ICE membership, the ICE Board of Directors has approved offering the DOFR at no cost.

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