Healthcare Medical Billing Contract

HEALTHCARE MEDICAL BILLING CONTRACT

This Medical Billing Contract (the Contract) is entered into by and between Provider Name: and Billing Company Name: . Effective Date: .

RECITALS

Whereas Provider is a duly licensed health care provider that provides medical services to patients; and whereas Billing Company is engaged in the business of preparing and submitting medical claims, posting payments, and pursuing fee-for-service collections on behalf of health care providers; Provider and Billing Company agree to the terms set forth below.

SCOPE OF SERVICES

Billing Company will perform medical billing services including, but not limited to: claims preparation and submission to payors, appeals and claim follow-up, posting of remittances, patient statement and collection activities, management reporting, and data entry necessary to submit claims.

Services commence on Billing Start Date: and shall continue subject to the Term provisions below.

TERM AND TERMINATION

The initial term of this Contract shall be for a period of months from the Effective Date and shall automatically renew for successive periods of months unless either party provides written notice of termination at least days prior to the end of the then-current term.

Either party may terminate for cause upon material breach if the breach remains uncured for a period of days following written notice specifying the breach.

COMPENSATION AND FEES

Provider agrees to compensate Billing Company as follows: a fee equal to of all gross collections recovered and processed by Billing Company on behalf of Provider. In addition, a monthly minimum fee of $ shall apply.

Billing Company shall remit net collections to Provider on a basis, within days of receipt of funds, accompanied by an itemized report.

PROVIDER RESPONSIBILITIES

Provider shall furnish Billing Company with accurate and complete clinical documentation, patient demographic information, insurance policy information, authorizations where required, and timely notice of any changes to patient or payor information. Provider warrants that services billed were medically necessary and documented in patient records.

BILLING COMPANY RESPONSIBILITIES

Billing Company will render services in compliance with applicable federal and state laws, payor policies, and accepted billing practices. Billing Company will attempt to resolve claim denials and denials due to coding or documentation issues, and will notify Provider of denials that require clinical response.

Submit and sign claims on Provider's behalf
Receive and endorse payments on Provider's behalf
Send patient statements and handle collections
File appeals and manage payor communications

PATIENT DATA, PRIVACY, AND HIPAA COMPLIANCE

Billing Company shall comply with the Health Insurance Portability and Accountability Act (HIPAA) and all applicable privacy and security laws in its use, disclosure, and safeguarding of Protected Health Information (PHI). Billing Company will implement administrative, physical and technical safeguards to protect PHI and shall only use PHI as necessary to perform services under this Contract.

Provider hereby authorizes Billing Company to access, use, and disclose patient information to the extent necessary to submit claims, obtain payment, and perform billing services. Provider shall obtain and maintain any patient authorizations required by law.

DATA SECURITY AND RECORDS

Billing Company shall maintain records of claims, remittances, and communications for a period of not less than years, and shall provide Provider reasonable access to records for audit and reconciliation upon request with reasonable notice.

INDEMNIFICATION; LIMITATION OF LIABILITY

Each party shall indemnify and hold harmless the other party from third-party claims arising from its negligence, willful misconduct, or breach of this Contract. Neither party shall be liable for incidental, consequential, punitive or special damages. The aggregate liability of Billing Company for any claim arising under this Contract shall not exceed the total fees paid to Billing Company under this Contract during the preceding months.

AUDIT RIGHTS

Provider shall have the right to audit Billing Company's performance, records, and remittance reports relating to Provider's accounts upon reasonable notice during normal business hours. Any such audit shall be at Provider's expense unless material discrepancies are discovered, in which event Billing Company shall reimburse reasonable audit costs.

NOTICES

MISCELLANEOUS

This Contract constitutes the entire agreement between the parties and supersedes prior agreements relating to the subject matter herein. No amendment shall be effective unless in writing and signed by authorized representatives of both parties. If any provision of this Contract is held invalid, the remainder shall continue in full force and effect.

PATIENT INFORMATION SAMPLE FIELDS (PROVIDER TO SUPPLY WHEN REQUESTED)

INSURANCE INFORMATION (EXAMPLE FOR BILLING SUBMISSION)

MEDICAL HISTORY FIELDS (FOR BILLING NOTE PURPOSES)

ACKNOWLEDGMENTS

Provider certifies that Provider has obtained all required patient consents and authorizations for Billing Company to receive and use Protected Health Information for payment and billing purposes. Provider acknowledges responsibility for clinical documentation and for responding to requests from payors that require clinical clarification.

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