MEDICAL SERVICE AGREEMENTS WITH MANAGED CARE ORGANIZATIONS
This class examines the medical service agreement between physicians and MCO’s. This agreement governs what the MCO’s will and will not pay for, what services can be provided without question, what services require prior permission, and perhaps the process by which exceptions are made. This agreement has the formula that tells how much providers are going to get paid. This class distinguishes basic terms of provider agreements with managed care organizations and how these terms effect the provider. Also, this class analyzes various payment mechanisms and how these mechanisms effect the provider. In addition, this chapter examines specialty contracting.
Class 7 Topics: MEDICAL SERVICE AGREEMENTS WITH MANAGED CARE ORGANIZATIONS
1. Distinguish basic terms of provider agreements with managed care organizations and how they effect the provider.
2. Analyze various payment mechanisms and how they effect the provider.
3. Summarize specialty contracting.
1. Explain the basic structure of a typical managed care organization’s contract with Primary Care Physicians.
2. Explain the advantages and disadvantages of withholding pools or bonus payments for efficient utilization as used in medical service agreements.
3. Explain four factors for success in specialty service contracts.