Is an electronic signature legally binding?

Yes. Under the ESIGN Act (15 U.S.C. §7001) and UETA (where adopted), electronic signatures are enforceable if intent, consent, attribution, and retention conditions are met.

Do I need a BAA for the billing vendor?

If the vendor handles PHI, include a HIPAA Business Associate Agreement and require breach notification and security controls per 45 CFR Part 164.

What happens if the vendor submits incorrect tax information?

Incorrect TINs can trigger backup withholding at 24% and information return penalties under IRC §6721; use accurate W-9 data to avoid withholding and fines.

Who should sign the agreement on behalf of the employer?

An authorized company officer or delegated signatory listed in corporate records should sign; obtain legal or procurement approval when required by company policy.

How can I revoke or amend the agreement?

Follow contract termination and amendment clauses; use written amendment signed by authorized parties and preserve prior records per retention rules and any active audit holds.

Where should executed agreements be stored?

Store signed originals and electronic copies in a secure, access-controlled repository with encryption and audit logs to meet HIPAA and IRS retention requirements.

Electronic Signature
Templates
HR
HR Medical Billing Agreement

HR Medical Billing Agreement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

HR MEDICAL BILLING AGREEMENT

Parties and Effective Date

This Medical Billing Agreement (the Agreement) is entered into on Effective Date: by and between Employer Name:

Employer Name Employer Address

and Billing Specialist Name:

Billing Specialist Full Legal Name Specialist Address

Recitals

WHEREAS, Employer operates medical practice(s) and requires professional medical billing, coding, claims submission, accounts receivable management and related services; and

WHEREAS, Specialist represents that Specialist has the requisite certifications, experience and authority to perform medical billing services in compliance with applicable law and standards, including but not limited to patient privacy and security obligations; and

NOW, THEREFORE, in consideration of the mutual promises herein contained, the parties agree as follows.

Services and Scope of Work

1. Services: Specialist shall perform professional medical billing and related services including coding, claim preparation and submission, payer follow-up, patient billing, posting of payments, denial management, and producing monthly reports (the Services). A detailed description of Services to be provided is set forth below.

Detailed Services Description

Position & Employment Information

Job Title Department Reporting Manager

Start Date: Employment Classification: Employee Contractor Full-time Part-time

Work Location

Compensation, Billing Rates & Expenses

Compensation for Services shall be as follows. Select and complete applicable fields below.

Base Salary or Hourly Rate (if applicable) Billing/Collection Percentage (if applicable) Payment Schedule Expense Reimbursement Policy

Confidentiality, Privacy & HIPAA Compliance

Specialist shall maintain the confidentiality of all Protected Health Information (PHI) in accordance with applicable federal and state law, including but not limited to HIPAA. Specialist shall implement administrative, physical and technical safeguards to protect PHI and shall permit Employer to audit such safeguards upon reasonable notice.

HIPAA Training Completion Date

Specialist acknowledges responsibility to report any unauthorized access, breach or suspected breach of PHI immediately to Employer and to cooperate in breach mitigation, notification and remediation.

Data Access, Records & Audit Rights

Specialist shall maintain complete and accurate records of billing activities and reimbursements and shall provide access to Employer for inspection and audit. Employer may require delivery of copies of records within a commercially reasonable period.

Record Retention Period

Term, Termination & Remedies

The term of this Agreement shall commence on the Effective Date and shall continue until terminated by either party as provided herein. Employer may terminate immediately for cause, including but not limited to material breach, violation of HIPAA, fraud, or intentional misconduct. Either party may terminate without cause by providing written notice of termination at least days prior to the effective termination date.

Insurance & Indemnification

Specialist shall maintain applicable professional liability and cyber/privacy insurance with limits reasonably acceptable to Employer and shall provide certificates of insurance upon request. Specialist agrees to indemnify and hold harmless Employer from and against any claims, liabilities, losses or expenses arising out of Specialist's gross negligence, willful misconduct, breach of this Agreement or violation of law.

Insurance Carrier and Policy Number

Compliance, Background Checks & Authorization

Employer may, in its discretion, require criminal background checks, references, verification of professional credentials and education, and sanctions screening. Specialist hereby authorizes Employer and its agents to obtain and verify such information.

I authorize Employer to contact previous employers and to conduct background checks, credential verification, and sanction screenings as necessary for my engagement.

Employment History

Provide the last two employers. Include responsibilities and reason for leaving.

Employer 1 - Company Name Employer 1 - Job Title

Start Date: End Date:

Employer 1 - Responsibilities Employer 1 - Reason for Leaving Employer 2 - Company Name Employer 2 - Job Title

Start Date: End Date:

Employer 2 - Responsibilities Employer 2 - Reason for Leaving

Education

Highest Degree Institution Graduation Date

Professional References

Provide three professional references.

Reference 1 - Name Reference 1 - Phone Reference 1 - Email Reference 1 - Relationship Reference 2 - Name Reference 2 - Phone Reference 2 - Email Reference 2 - Relationship Reference 3 - Name Reference 3 - Phone Reference 3 - Email Reference 3 - Relationship

Legal Disclosures

At-Will Employment: If Specialist is engaged as an employee, employment is at-will and may be terminated at any time by either party, with or without cause, unless otherwise expressly agreed in a separate written agreement signed by an authorized representative of Employer.

Equal Opportunity: Employer is an equal opportunity employer. Employer does not discriminate on the basis of protected characteristics in recruitment, hiring, compensation, training, promotion, termination or any other employment-related decision.

I acknowledge receipt of and understand the At-Will Employment statement.

I acknowledge receipt of and understand the Equal Opportunity statement.

Applicant Certification & Authorization

I certify that all information provided in this Agreement and the accompanying application materials is true, complete and correct to the best of my knowledge. I understand that any material misrepresentation or omission may constitute grounds for termination or denial of engagement. I authorize Employer to verify any information provided, contact references and previous employers, and obtain background and credential reports. I consent to Employer's lawful processing of my personal data for purposes of recruitment, engagement and compliance with applicable law.

I further certify that I will comply with Employer policies regarding patient privacy, recordkeeping, security and fraud, waste and abuse prevention, and will promptly report suspected noncompliance or improper billing to Employer.

Applicant Printed Name Applicant Email Applicant Phone

Miscellaneous Provisions

Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the state in which Employer's principal place of business is located, without regard to conflicts of law principles. Venue for any action arising under this Agreement shall be in the state or federal courts located in that jurisdiction.

Entire Agreement; Amendment: This Agreement constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior or contemporaneous agreements and understandings. Any modification or amendment must be in writing and signed by both parties.

Employer:

By:

Date:

Billing Specialist:

By:

Date:

What the HR Medical Billing Agreement Is

An HR Medical Billing Agreement is a written contract that defines the relationship between an employer or HR department and a billing services provider for handling medical claims, patient invoicing, and related revenue-cycle management tasks. It specifies responsibilities, data access, billing rates, coding standards, error correction procedures, and privacy safeguards required when protected health information (PHI) is exchanged or processed.

Why an Agreement Matters for HR and Payroll

This agreement reduces operational ambiguity, assigns liability, and documents HIPAA and tax-related obligations when HR coordinates medical billing or benefits claims. Clear terms protect employee data, set billing performance expectations, and simplify audits.

Who Typically Completes an HR Medical Billing Agreement

Several organizational roles commonly prepare or approve this agreement depending on company size and structure.

HR leadership and benefits managers who control employee health plan interactions and vendor selection.
Finance or payroll teams that reconcile billed amounts, reimbursements, and tax reporting responsibilities.
Compliance or privacy officers responsible for HIPAA, data-sharing controls, and business associate oversight.

In smaller organizations one person may perform multiple roles; in larger entities, legal review and procurement sign-off are normal steps.

Authorized Signers and Typical Roles

HR Director

Typically reviews service-level provisions, approves data access for third-party billers, and signs on behalf of the employer after legal and finance clearance. Often ensures alignment with employee benefit plan terms and internal payroll systems.

Billing Vendor CEO

Signs for the billing company and accepts performance obligations, indemnities, and compliance requirements such as HIPAA and PCI where payment card data is processed. Responsible for subcontractor oversight and audit cooperation.

Step-by-Step: Completing the Agreement

Follow these sequential steps to prepare, review, and execute an HR Medical Billing Agreement properly.

01

Gather parties: List full legal names and business addresses for employer and vendor.
02

Define services: Specify billing activities, claim submission, corrections, and appeals.
03

Add compliance clauses: Include HIPAA BAA, data security, and audit rights.
04

Sign and retain: Execute with authorized signatures and store per retention rules.

Typical Submission and Approval Flow

A predictable workflow reduces rejected claims and supports timely reimbursement.

Document upload: HR or vendor uploads signed agreement to a secure repository.
Data exchange setup: Vendor configures EDI or portal access with payer credentials.
Claims submission: Vendor files claims, tracks adjudication, and posts remittances.
Reconciliation: Finance matches remittances and resolves denials with documented corrections.

Configuring the Digital Workflow

Key configuration choices determine security, authentication, and routing for signed agreements and billing data.

Field	Configuration
Authentication method	Email + SMS code or SSO
Routing order	Sequential signing with approver gates
Conditional fields	Show fee fields when vendor selected
Audit trail	Capture IP, timestamp, and actions

Technical and Integration Considerations

Confirm integrations and file formats to avoid later compatibility issues.

Integrations: Salesforce, NetSuite, Google Workspace
Supported formats: PDF, DOCX, XLSX
Authentication: SSO, two-factor options

Ensure your eSignature provider supports required integrations and security standards before deployment.

Core Elements to Include in an HR Medical Billing Agreement

A complete agreement covers operational, financial, security, and compliance matters to govern the billing relationship.

Parties

Full legal names, addresses, and authorized signers for employer and vendor, plus any subcontractors that will handle PHI or claims.

Scope of services

Detailed description of tasks such as claim submission, denials management, payment posting, patient statements, and collections.

Fees and reconciliation

Fee schedule, timing of payments, dispute resolution procedures, and how remittances and chargebacks are reconciled.

Coding and documentation

Standards for CPT/ICD coding, documentation retention, claim edits, and required supplemental paperwork for payers.

Compliance and privacy

HIPAA business associate agreement terms, security controls, breach notification timelines, and obligations for audits.

Audit and termination rights

Rights to audit vendor records, remedial actions for performance shortfalls, notice periods, and steps for secure data return on termination.

Supporting Documents to Attach

Attach companion documents that clarify operations and ensure audit readiness.

Business Associate Agreement

A HIPAA BAA that defines permitted uses of PHI, safeguards, breach notification, and subcontractor flow-down obligations.

Fee schedule exhibit

Detailed pricing worksheet showing rates, discounts, and billing cadence tied to reporting metrics.

Process flow diagram

Operational diagram showing claim submission steps, error handling, and escalation points for denials management.

Data mapping sheet

Field-level mapping for EDI files or API exchanges, including required payer identifiers and formats.

Key Dates and Filing Deadlines to Track

Certain tax and information-reporting deadlines intersect with billing operations; track these dates proactively.

W-9 provision:

Provide upon payer request; no fixed IRS deadline.

1099-NEC deadline:

Reports to recipients and IRS due Jan 31.

1099-MISC deadlines:

Recipient copies due Jan 31; paper IRS Feb 28; electronic IRS Mar 31.

Form 1040 individual:

April 15 filing deadline for personal tax returns.

I-9 retention:

Retain per 8 CFR §274a.2: three years after hire or one year after termination.

Security and Compliance Controls to Include

Encryption: AES-256 at rest

Transport Security: TLS 1.2/1.3 in transit

Certifications: SOC 2 Type II

HIPAA Support: BAA available

Audit Trail: Detailed event log

Accessibility: WCAG 2.0 AA

Regulatory Penalties and Financial Risks

1099 Penalties: Per-form fines

Backup Withholding: 24% withholding rate

I-9 Violations: $281–$2,789 per violation

HIPAA Fines: Civil monetary penalties apply

Breach Costs: Notification and remediation expenses

Contractual Liability: Indemnity and reputational loss

Common Preparation Mistakes to Avoid

Using informal language for fees or obligations leads to ambiguity and disputes over billing entitlements and timing.
Failing to attach a BAA when PHI is shared can create HIPAA compliance gaps and regulatory exposure.
Providing incomplete payer identifiers or NPIs causes claim denials and slows reimbursement cycles.
Not defining performance metrics for denial management or dispute resolution leaves recovery responsibilities unclear.

How This Agreement Differs from Related Documents

Compare the HR Medical Billing Agreement with similar documents to confirm you have the right instrument.

Document Type	PHI Covered	Typical Use
HR Medical Billing Agreement		outsourced billing and claim management
Service Agreement		general vendor services, non-phi
Business Associate Agreement		hipaa compliance obligations only
Authorization to Release		limited consent for specific disclosures

eSignature Vendor Pricing and Feature Comparison

A concise vendor comparison for eSignature plans and key attributes relevant to handling agreements that include PHI; signNow is listed first per vendor ordering rules.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently Asked Questions and Troubleshooting

Answers to common questions about validity, signing, and compliance for HR Medical Billing Agreements.

Need help? Contact support

Is an electronic signature legally binding?
Yes. Under the ESIGN Act (15 U.S.C. §7001) and UETA (where adopted), electronic signatures are enforceable if intent, consent, attribution, and retention conditions are met.
Do I need a BAA for the billing vendor?
If the vendor handles PHI, include a HIPAA Business Associate Agreement and require breach notification and security controls per 45 CFR Part 164.
What happens if the vendor submits incorrect tax information?
Incorrect TINs can trigger backup withholding at 24% and information return penalties under IRC §6721; use accurate W-9 data to avoid withholding and fines.
Who should sign the agreement on behalf of the employer?
An authorized company officer or delegated signatory listed in corporate records should sign; obtain legal or procurement approval when required by company policy.
How can I revoke or amend the agreement?
Follow contract termination and amendment clauses; use written amendment signed by authorized parties and preserve prior records per retention rules and any active audit holds.
Where should executed agreements be stored?
Store signed originals and electronic copies in a secure, access-controlled repository with encryption and audit logs to meet HIPAA and IRS retention requirements.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now