Our free medical billing contract template helps ensure you have a base document to work off when billing your clients. Billing services and records are crucial, as they provide both Parties with an understanding of the services the other pays for. It also ensures that you can take specific steps should you not get paid on time. However, this document type has a few required terms, so it’s best to work from a template.
This Medical Billing Contract (“Contract”) is effective as of (Effective.Date) (“Effective Date”), and is made by and between [ServiceProvider.FirstName] [ServiceProvider.LastName] , a [ServiceProvider.State] company with its principal offices at [ServiceProvider.StreetAddress] [ServiceProvider.City] [ServiceProvider.PostalCode] (ServiceProviderEstablishment.Address) (“Service Provider”) and [Client.FirstName] [Client.LastName] , a [Client.State] medical company with its principal offices at [Client.StreetAddress] [Client.City] [Client.PostalCode] (MedicalEstablishment.Address) (“Client”).
WHEREAS, the Service Provider is a medical billing services company providing computerized billing, claims, and collection services to their patients on behalf of healthcare providers.
WHEREAS, the Client wishes to retain the Service Provider to provide medical billing services (“Services”) under the terms of this Contract.
THEREFORE, considering the mutual covenants and responsibilities outlined in this Contract, both Parties agree to the following terms.
We provide a generalized description but recommend you adjust it to reflect your services. Part of the medical billing agreement format is to describe in detail what you’ll do, so don’t leave out anything. Note that third-party payers refer to medical insurance companies or any other party which pays on the patient’s behalf.
The Client authorizes the Service Provider to prepare, process, and submit claims to commercial and governor payors on their behalf. It is the responsibility of the Service Provider to obtain reimbursement from the patients of the Client for all medical services and clinical procedures they provide. Service Provider will submit these claims in the name of the Client and utilize any provider numbers a third party assigns to the Client.
Service Provider will submit claims electronically or by paper submission, dependent on the direction of the third-party payor. Payments from third-party payors will be directed to accounts over which the Client holds authority. The Service Provider will add any third-party payor payments to the file of the appropriate patient. As such, the Service provider may also bill the patient directly should there be an outstanding balance the third-party payor doesn’t cover.
Ensure the other Party also completes all responsibilities as expected of them. The primary responsibilities are reasonable assistance from the Client, systems access to their files to create bills, and the Client’s acknowledgment to provide these.
The Client will provide the Service Provider will all required information, records, and assistance needed to enable the Service Provider to provide the Services. The Client is responsible for ensuring the accuracy of these records and information. The Client must also promptly provide all Explanation of Benefits forms they receive to the Service Provider.
The Client must give the Service Provider access to its practice management software so they can facilitate the submission of medical claims. The Client acknowledges and agrees that they are responsible for all submitted claims. The Client is also responsible for maintaining the original documents, which enables them to verify and document claims submitted by third-party payors.
The fees are critical, as you want to ensure you don’t receive non-payments for certain services. You can charge a flat fee each month or a percentage of the amounts you collect. You should carefully decide which works better for your business and the marketplace surrounding you and the Client.
The Client will pay the Service provider for its Services a monthly fee of $(Set.Amount)/(Number)% of the monthly net collections. If the Client requires that the Service Provider print and mail the patient statements, the Client agrees to reimburse the Service Provider at $(Amount) per mailed patient statement.
Note that it can change depending on your state, but generally, the monthly net percentage you ask for is around 5.99%. The fee for mailed statements is usually around $1, but you can change it as required and based on the pricing in your area. Payments are generally due within 30 days, with disputes happening within 20 days. Lastly, the monthly interest percentage can change depending on your state, but it’s usually around 2%.
Service Provider will invoice the Client at the start of the month for the Services of the previous month. The invoice must contain a detailed list of Services and their calculated payment. Payments are due within (Number) days of receiving the invoice receipt.
If the Service Provider does not receive a payment within (Number) days, then a late fee of $(LateFee.Ampunt), or a (Number) % monthly interest, whichever is greater, will apply. Parties must dispute invoices within (Number) days of invoice receipt, after which it can no longer be disputed.
A typical medical billing agreement format requires a section on confidentiality and HIPAA. This compliance ensures patient information stays secure. It further ensures the document is legal by following all HIPAA regulations. The main ones for billing services are the Security and privacy rules.
Service Provider agrees to not share in any way confidential information they gain access to during the performance of the Services. This data includes patient information and sensitive data on the medical facility, its associates, partners, employees, owners, and patients.
Both Parties agree to comply with HIPAA regulations in security. The Security rules state that confidential information, such as patient data, will be securely protected by robust security measures in a physical location. Further, both Parties acknowledge that their cybersecurity measures and systems are up to date as per HIPAA standards. Both Parties must adequately train all employees to handle PHI and HIPAA guidelines.
According to the Privacy Rule, the Service Provider can only have access to the medical history, conditions, treatments, treatment facility locations, and third-party payor fees of patients. They are not entitled to any other patient information.
This Contract will remain in effect until (End.Date) (“End Date”) or until both Parties agree to terminate it in writing. A breach in terms of the Contract can also result in the termination of the agreement. A (Written.Number) (Number) days written notice period is required for termination by a Party, along with a thorough explanation.
Once the Contract is terminated, the Service Provider will no longer have access to the systems of the Client. The Client must also pay and settle any outstanding fees, claims, or charges that are pending or in transit.