Key Elements of Managed Care Contract

Elements of Managed Care Contract
Key Elements of Managed Care Contract

Identify the key elements of a managed care contract and identify the role HIPAA plays in the health care industry.

H07 Medical Coding I

Directions:  Be sure to make an electronic copy of your answer before submitting it to Ashworth College for grading.  Unless otherwise stated, answer in complete sentences, and be sure to use correct English spelling and grammar.  Sources must be cited in APA format.  Your response should be two (2) to four (4) pages in length; refer to the “Assignment Format” page for specific format requirements.

Lesson 1, 2, 3, and 4 of this course has covered a wide variety of topics. Thus far, you have learned a great deal of information on health insurance, medical contracts, HIPAA, physician and hospital medical billing, and Medicare and Medicaid.

For this writing assignment, please explain why the following course objectives are important for medical billers and coder to understand:

1.      Understand the history and impact of health insurance on health care reimbursement process and recognize various types of health insurance coverage.

2.      Identify the key elements of a managed care contract and identify the role HIPAA plays in the health care industry.

3.      Recognize and explain the different components of physician and hospital billing and differentiate between the two types of services.

4.      Explain the difference between Medicare and Medicaid billing.

Please include at least 3 scholarly articles within your response. Overall response will be formatted according to APA style and the total assignment should be between 2-4 pages not including title page and reference page.

The managed care plan is the health insurance that is common in the U.S. today. They are based on contact among healthcare providers and medical facilities to provide services and care at a low cost. 

Step-by-step explanation

Key elements of a managed care contract

  • Clear standards and cut rules for choosing a care provider.
  • Continued quality improvement program.
  • The financial motive for enrollees to be in-network.
  • Ensuring that enrollees maintain their health which helps in decreasing the need for services.

Role HIPAA plays in the health care industry.

  • HIPAA helps in the transition of health information from paper records to electronic copies.
  • It streamlines healthcare administrative functions and improves healthcare industry efficiency.
  • HIPAA makes sure that health information is protected and shared securely. 
  • It helps in transferring the electronic health information among health plans, healthcare providers, and other entities.


– HIPAA/HITECH overview. (2012). The Definitive Guide to Complying with the HIPAA/HITECH Privacy and Security Rules, 40-77.

Appendix 11: Managed care contracting: Sample managed care contract. (2014). Transplant Administration, 225-227.

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