Healthcare Collection Contract

HEALTHCARE COLLECTION CONTRACT

This Healthcare Collection Contract (the Agreement) is entered into as of by and between Provider Name: (the Provider), and Collector Name: (the Collector). Provider and Collector are sometimes referred to herein individually as a Party and collectively as the Parties.

1. Definitions

"Assigned Accounts" means patient accounts of the Provider submitted to Collector for collection pursuant to this Agreement. "Protected Health Information" or "PHI" has the meaning set forth under applicable federal and state law and includes individually identifiable health information transferred by Provider to Collector in connection with collection activity.

2. Appointment and Scope of Services

Provider hereby appoints Collector to act as Provider's limited agent to pursue collection of Assigned Accounts and to perform reasonable collection-related activities, including patient contact, credit reporting, placement with third-party attorneys, and litigation when specifically authorized in writing. Collector shall act only within the scope expressly authorized by Provider and in accordance with applicable law.

3. Term

The term of this Agreement shall commence on the effective date and shall continue until terminated by either Party upon thirty (30) days' written notice, subject to Sections governing survival of rights and obligations with respect to accounts submitted prior to termination.

4. Fees, Costs, and Remittance

Collector's fee for successful recoveries shall be a contingency fee of % of amounts actually collected and remitted to Provider, unless otherwise agreed in writing. Collector may also advance reasonable third-party costs and attorney fees with prior written authorization; such advances shall be reimbursed from collections before calculation of the contingency fee, unless otherwise agreed.

Collected funds shall be remitted to Provider within calendar days after receipt, accompanied by an itemized report identifying account numbers, patient names, dates of service, gross recoveries, fees, advances, and net remittance.

5. Account Submission; Patient Information

Provider shall submit account information in a secure, auditable format containing only information reasonably necessary for collection. For each account submitted, Provider will provide patient information as follows.

6. HIPAA, Privacy, and Security

Provider warrants that Provider has the legal right to disclose PHI to Collector for the limited purpose of collection and that such disclosure complies with all applicable privacy laws. Collector agrees to implement appropriate administrative, physical, and technical safeguards to protect PHI, to use PHI only as permitted by this Agreement, and to execute a Business Associate Agreement when required by law. Collector shall promptly notify Provider of any unauthorized use or disclosure of PHI.

7. Compliance with Law

Collector shall at all times comply with applicable federal and state consumer protection, debt collection, privacy, and healthcare laws and regulations, including but not limited to applicable provisions governing communications with patients, credit reporting, and litigation. Provider represents that accounts submitted are valid obligations and that Provider will not submit accounts that are legally unenforceable.

8. Audit, Reporting, and Record Retention

Collector shall maintain accurate records of collection activities and make such records available to Provider upon reasonable notice for audit and inspection for audit purposes. Provider shall have the right to audit Collector's compliance with PHI safeguards on reasonable notice and during regular business hours; audits shall be conducted in a manner to avoid unreasonable disruption.

9. Indemnification and Limitation of Liability

Each Party shall indemnify, defend, and hold harmless the other Party from and against any losses, liabilities, damages, and expenses arising from the indemnifying Party's breach of this Agreement, negligent acts, willful misconduct, or violations of law. EXCEPT FOR WILLFUL MISCONDUCT OR GROSS NEGLIGENCE, NEITHER PARTY SHALL BE LIABLE FOR INCIDENTAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES.

10. Termination; Effect on Assigned Accounts

Either Party may terminate this Agreement upon thirty (30) days' written notice. Termination shall not affect Collector's right to recover fees on accounts collected after termination if those accounts were submitted prior to termination. Provider may, at its option, request transfer or return of account records in a mutually agreed electronic format at Provider's expense.

11. Notices

All notices under this Agreement shall be sent to the addresses set forth below and shall be deemed delivered when received by hand, by certified mail, or by other documented delivery service.

12. Miscellaneous

This Agreement constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior agreements. No amendment shall be effective unless in writing and signed by both Parties. If any provision of this Agreement is held invalid, the remainder shall continue in full force. This Agreement shall be governed by the internal law of the state of without regard to conflict of law principles.

13. Certification and Acknowledgement

Each Party certifies that it has the authority to enter into this Agreement and that the person signing below is authorized to bind the respective Party. Provider certifies that accounts submitted are permitted to be disclosed for collection and that Provider will obtain patient authorizations where required by law. Collector certifies that it will limit its use and disclosure of PHI to the purposes set forth in this Agreement.

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