ME1125: Week 3 Assignment Worksheet
About
It is imperative that billing professionals know all aspects of the managed care contract and the related stakeholders
in the contracting process. Such contracts outline expectations of all involved and lay out specific terms for payment
for services rendered. This assignment examines key aspects of the contracting process.
Background
Michelle, the recent UMA MOBS graduate who now works in her pediatrician’s practice, is attending orientation for
her medical office specialist role. This week, her mentor explains why contracting with MCOs is crucial to the life of
the practice. The mentor also explains the common types of managed care contract payment types and how the
practice must bill in order to guarantee that they are compensated. In this assignment you will examine these types of
contracts. Part 1: Contracting for Outside Services 20 points Directions to complete part 1:
Please see Chapter 3 in order to identify key concepts related to the process of managed care contracts for outside
services.
A key element of any managed care contract is the provider’s __________________ for services.
Type answer here
A managed care contract is a legal agreement between a ______________ and a managed care organization, for
example an insurer, health maintenance organization (HMO) or other network.
Type answer here
A medical office specialist should always _______________, ________________ and ____________ all
conversations regarding any patient’s account whether the conversation is with the provider, patient, or carrier.
Type answer here, Type answer here, and Type answer here
MCOs contract with __________, __________, ________________, and _______________ to offer a full-service
network of providers who have agreed to discount their fees for members of the managed care plan
Type answer here, Type answer here, Type answer here, and Type answer here
(See next page to continue part 1) ME1125: Week 3 Assignment Worksheet
A _____________________ will contract with a physician or facility to handle all claims submissions.
Responsibilities will vary, but normally involve taking control of the account after a patient visit, from submission
of the claim to resolution of the claim and anything that happens in between.
Type answer here

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