Medical Billing Contract Agreement Samples

 
 
 

example medical billing contractDo You Need Samples Of Medical Billing Contracts &
Medical Billing Business Associate Agreements
For Your New Medical Billing Business?

 
 

We will discuss the differences between the two, how each one is worded, what must be included and how they are used in regard to your medical billing businesses.

  

Before I give you a sample of a medical billing contract you need to know that while all medical billing contracts are similar… None Are Exactly The Same.  

Why? Simply put, no one business is the same. One of the biggest mistakes people make when starting their home based medical billing service (to save money or so they think) is:

 

Copying someone else’s business contract/agreement!!!

 

So what I intend to do on this website is:

 

1. Show you what a 3rd party medical billing service agreement looks like so you can get a better understanding of how they are worded, then…

 

2. You’ll learn the 10 basic points your contract/agreement must cover at the very least, and…

 

3. Lastly, I will recommend you to the ONLY resource on or offline that has helped hundreds of home based medical billing business owners like you create and properly construct their medical billing contracts to properly protect themselves and their businesses.

  

medical billing business contracts and agreements author imageWhy Should I Listen To Your Contracts & Associate Agreements Advice?

 

Great question and I would be shocked if you didn’t want to know!!! Hello, my name is Paul G. Hackett and I thank you for taking the time to visit today!

 

Listen… I could list all the accomplishments that have made me the billing, coding and transcription business expert I am today however, I created this page specifically for your benefit so I will not do so here!

 

However, you deserve the opportunity to learn more about me so here is a link that is dedicated to who I am, what I’ve gone through in my own businesses, why I have chosen to mentor others, etc., so please click here. Now let’s proceed to:

 

 

Medical Billing Contracts; Here’s A Sample Of One

  

Please Note: I do STRESS That You Do Not Use It As Is. Use this sample to get ideas of what’s included in a basic contract, use it to get familiar with the verbiage that’s used and then finally once you have crafted a working draft from this example then have it looked over by a business lawyer (with a background in healthcare). OK, now that I have covered all the legal issues here is the sample:

  

Medical Billing Contract For Full Practice Management

 

This Medical Billing Agreement is entered into between Acme Medical Billing LLC, a (hereinafter “ACME”), a healthcare electronic claims processing and services company and _________________, (hereinafter “Client”), a healthcare provider.

 

WHEREAS, ACME is a healthcare billing and service company which provides computerized claims, billing and collection services to healthcare providers and which files medical insurance claims on behalf of healthcare providers with government and commercial companies by electronic and paper means, and which also provides for billing services directly to patients or for patient’s portion of healthcare provider fees not covered by insurance; and,

 

WHEREAS, the Client desires to retain ACME to provide it with claims and billing services whereby ACME will file insurance claims with government and commercial companies by electronic and paper means on behalf of Client;

 

NOW, THEREFORE, in consideration of the promises and covenants contained herein and for other valuable consideration, the receipt and adequacy of which is hereby acknowledged, the parties agree as follows:

 

1. Commencing on __________________, ACME will process all the Client’s medical insurance claims for payment by government and commercial companies by either electronic or paper means. The Client agrees to make available to ACME all information necessary to properly process the Client’s claims and to submit all such billing and insurance information to ACME (Daily, MWF, Weekly). In return, Billing Center will process and submit all Client’s claims within seventy-two (72) hours by electronic means wherever possible, and by paper means otherwise. The scope of services provided by ACME will be as follows (List additional services or terms here):

 

a.

b.

c.

d.

e.

f.

g.

 

2. ACME will provide to Client a direct fax number, through which the Client will provide to Billing Center claims and billing information necessary for ACME to properly process the Client’s claims.

 

3. All patient information and data provided by the Client to ACME shall be kept confidential and shall not be disclosed to anyone outside of ACME other than to the extent necessary for ACME to process and submit claims for the Client. In addition, the Client will not divulge the contents, terms or conditions of any of our medical billing contracts to any third party without the express written consent of ACME.

 

4. The Client will pay ACME a one-time setup fee of $______ to cover the cost of gathering information from the Client and setting up the Client’s files for entry into computer system. The information and initial setup covered by this initial fee includes, but is not limited to: Doctor Profile; Listing of Current Insurance Companies Used; Referring Physicians; Facilities at Which Doctor is Accepted or Transfers Work; Diagnostic Codes; Procedure Codes and Fees; Signed Patient Registration Forms (to be kept in Client’s office); Registration with Clearinghouse which will distribute claims to the carriers.

 

5. The Client will pay to ACME ____% of the total (gross) amount collected from ALL insurance companies and ALL patients as a result of the billing services performed by ACME for Client, with a $500 monthly minimum billed amount. The Client agrees to provide copies of all Explanation of Benefits (EOB) forms received from insurance payors to ACME as well as records of payments received directly from patients (Weekly). ACME shall post the payments received from the insurance payors to the patient’s file, shall file any secondary or tertiary claims, and shall bill the patient directly when necessary in order to secure full payment for the Client.

 

6. ACME shall provide to Client management reports regarding the practice on a timely basis. The types of Monthly Management Reports shall be as follows:

 

a. Insurance Aging Report – monthly

b. Patient Aging Report – quarterly

c. Practice Analysis – monthly

d. Other(s) __________________________

 

7. ACME will close its books for billing purposes on the last day of each month and will bill the client for its services on the 5th business day of each succeeding month for the previous month’s processing. The Client will pay ACME for its services upon receipt of receiving ACME’s invoice. If the Client fails to submit payment within the time set forth in this paragraph, the Client will be responsible for paying, in addition to the principal amount billed, a 1% per month late charge for each month or any portion thereof payment of the billing is late.

 

8. During the term of this medical billing contract, the Client will not use the services of any other claims processing companies and will allow ACME to process all of the Client’s medical insurance claims with the government and commercial companies.

 

9. Either party may terminate this medical billing service agreement at any time by providing a thirty (30) day written notice with explanation or reason why termination is desired to the other party.

 

10. ACME will be serving as a conduit of information and claims data between Client and many insurance payers, both government and commercial. Client will be providing all such claims information and data to ACME, including but not limited to procedure codes, identifying the exact procedures Client has performed on patients. Client verifies that all such procedures were in fact performed on the patients as specified. ACME has no authority to and will not change any of these procedure codes without the express permission and direction of Client.

 

11. Client understands that ACME is relying entirely on the claims and billing information supplied to ACME by Client in preparing and submitting insurance claims for payment on behalf of Client. Client warrants and represents that all such claims and billing information is entirely accurate and truthful. If any investigation is initiated or if any action is brought by any individual, company or entity whatsoever regarding any of the claims filed by ACME on behalf of Client, then Client agrees to cooperate fully in any such investigation or action and shall provide all relevant supporting documentation to support the claim(s) filed.

 

12. Client understands that ACME will NOT provide insurance pre-authorizations.

 

13. Client agrees to indemnify and hold ACME harmless for any and all damages or penalties imposed and any attorney’s fees incurred by ACME in defending any such action resulting from Client’s failure to provide truthful and accurate billing and claims information to ACME.

 

14. This medical billing contract shall be interpreted under the laws of the State of Georgia and any disputes between the parties concerning the validity, interpretation or performance of any of the terms or provisions of any of our our medical billing contracts or of any rights or obligations of the parties hereto shall be resolved in Georgia. Should it become necessary for ACME to retain an attorney to collect any amounts owed to ACME under the terms of this Service Agreement, ACME will be entitled to recover in addition to its damages, reasonable attorney’s fees.

 

15. Any notices or communications anticipated by this Service Agreement shall be directed to the parties, as follows: BILLING CENTER: (Type company rep and contact info here) CLIENT:(Type client’s name and title here)

 

16. This medical billing service agreement represents the entire agreement between the parties and shall not be modified unless done so in writing signed by or on behalf of both parties.

 

17. This medical billing contract shall be binding upon and inure to the benefit on the heirs, legatees, successors, and assigns of each of the parties.

 

Executed this _______day of _______________, _________.

By: ___________________________________ (Client signature and title)

By: ___________________________________ (Billing service representative signature and title)

 

(End Of Medical Billing Contract Sample)

  

2 Ways To Correctly Create Medical Billing Contracts & The 10 Points
(At The Very Least) That Need To Be Included

 

1) You can hire a business lawyer with a background in healthcare business practices to draw one up for you at an astronomical price or,

 

2) You learn how to correctly draw one up yourself.

 

Doing anything else (even if it greatly reduces your initial expenses) will doom you and your business if you must sue a client or worse…If a client sues you!

 

Your medical billing contract is the cornerstone of your business because it:

 

1. Sets YOU apart from every other medical billing service

 

2. It clearly defines YOUR responsibilities to your clients

 

3. It clearly defines the rolls and responsibilities of YOUR CLIENTS and THEIR STAFF

 

4. It clearly defines the services YOU will provide to the client

 

5. It clearly defines the prices YOU will charge clients for performing those services

 

6. Well put together medical billing contracts clearly defines the costs of services YOU will charge your clients extra for (late payment fees, overage fees, detailed reporting fees, fees for any services requested above and beyond the services you have agreed to, etc.)

 

7. It clearly defines what action (monetary, legal, etc.) will be taken if YOU fail to live up to your service contract

 

8. It clearly defines what action (monetary, legal) YOU will take if your CLIENT fails to live up to the rolls and responsibilities outlined within your medical billing contract

 

9. It clearly defines the rolls and responsibilities of YOUR CLIENTS and THEIR STAFF with regard to HIPAA Privacy Rules and the proper reporting of HIPAA Violations. In turn your client may have you sign what’s known as a Business Associate Contract. This document states that The Provider a.k.a Your Client (a covered entity) has an enforceable agreement with a certain Medical Billing Service a.k.a You (3rd party business entity) to comply with all of the requirements outlined within the current HIPAA Privacy Rule.

 

10. It clearly defines the rolls and responsibilities of YOU and YOUR STAFF with regard to HIPAA Privacy Rules and the proper reporting of HIPAA Violations. That’s just a small sample of the clauses that need to be addressed within all medical billing contracts and service agreements.

Are You Ready To Learn How To Write Your Own
Fully Enforceable Medical Billing Contract For Your Business?

Today you will learn… with the assistance of the following 82 page, step-by-step, medical billing contract and billing service agreement builder created by two expert home based medical billing business owners from New York.

 

The “Write A Kick Butt Contract For Your Medical Billing Service” ebook is the ONLY book on or offline that covers every aspect of easily drawing up medical billing contracts.

 

You don’t have to waste your valuable time trying to track down unusable samples of medical billing service agreements online.

 

I’ve said it before and I’ll say it again; “Outside of a Healthcare Business Attorney ONLY a person that owns and operates a successful home based medical billing business and is in the medical billing trenches on a daily basis is qualified to properly teach you the process”!. Do yourself a favor today and download your own copy of the:

  

Write A Kick Butt Contract For Your Medical Billing Service

 
 

examples of medical billing contractsMedical Billing Business Associate Agreements Differ From Medical Billing Contracts

  

As stated in the last section, medical billing contracts spell out what billing services you will provide a physician/doctors office (known as a Covered Entity) and what you expect in return from the physician/doctors office.

 

Medical billing business associate agreements (BAA) are contracts that spell out what a Covered Entity (physician/doctors office) expects of your billing service with regard to the way you handle, secure and transmit, store and destroy their Patients Health Information (PHI) under the rules of HIPAA (Health Insurance Portability & Accountability Act).

 

The majority of the Covered Entities you bill for will ask that you sign a BAA and if they don’t it is best that you suggest they do so. This covers the both of you if any litigation should arise in the future as the consequences of not having one can be severe.

 

The Office of Civil Rights (OCR) could request a copy of a covered entity’s BAA at any time and they most certainly will if there is a complaint registered over a covered entity or if a breach occurs.

 

Violations under HIPAA can be penalized at anywhere between $100 to $50,000 per violation, up to a calendar year maximum penalty of $1,500,000 for a single violation.

 

The OCR could take the position that every day that the BA (you) and covered entity (your doctor/client) did not have a medical billing business associates agreement is a violation, and multiply the fine by the number of days no BAA penalty was in place, so the penalties can become very steep.

 

Medical Billing Business Associate Agreements; Here’s An Sample Of One

 

Please Note: I do STRESS That You Do Not Use It As Is. Use this example to get ideas of what’s included in a basic business agreement, use it to get familiar with the verbiage that’s used and then finally once you have crafted a working draft from this sample. OK, now that I have covered all the legal issues here is the example.

  

Sample Medical Billing Business Associate Agreement

  

Words or phrases contained in brackets are intended as either optional language or as instructions to the users of these sample provisions.

 

Definitions

 

The following terms used in this Medical Billing Business Associate Agreement shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required By Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.

 

Specific definitions:

 

(a) “Medical Billing Business Associate” shall generally have the same meaning as the term “business associate” at 45 CFR 160.103, and in reference to the party to this agreement, shall mean [Insert Name of Business Associate].

 

(b) “Covered Entity” shall generally have the same meaning as the term “covered entity” at 45 CFR 160.103, and in reference to the party to this agreement, shall mean [Insert Name of Covered Entity].

 

(c) “HIPAA Rules” shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164.

  

Obligations and Activities Of Medical Billing Business Associate

  

Medical Billing Business Associate agrees to:

 

(a) Not use or disclose protected health information other than as permitted or required by the Agreement or as required by law;

 

(b) Use appropriate safeguards, and comply with Sub-part C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of protected health information other than as provided for by the Agreement;

 

(c) Report to covered entity any use or disclosure of protected health information not provided for by the Agreement of which it becomes aware, including breaches of unsecured protected health information as required at 45 CFR 164.410, and any security incident of which it becomes aware;

 

[The parties may wish to add additional specificity regarding the breach notification obligations of the medical billing business associate, such as a stricter time frame for the business associate to report a potential breach to the covered entity and/or whether the business associate will handle breach notifications to individuals, the HHS Office for Civil Rights (OCR), and potentially the media, on behalf of the covered entity.]

 

(d) In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the business associate agree to the same restrictions, conditions, and requirements that apply to the business associate with respect to such information;

 

(e) Make available protected health information in a designated record set to the [Choose either “covered entity” or “individual or the individual’s designee”] as necessary to satisfy covered entity’s obligations under 45 CFR 164.524;

 

[The parties may wish to add additional specificity regarding how the medical billing business associate will respond to a request for access that the business associate receives directly from the individual (such as whether and in what time and manner a business associate is to provide the requested access or whether the business associate will forward the individual’s request to the covered entity to fulfill) and the time frame for the business associate to provide the information to the covered entity.]

 

(f) Make any amendment(s) to protected health information in a designated record set as directed or agreed to by the covered entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy covered entity’s obligations under 45 CFR 164.526;

 

[The parties may wish to add additional specificity regarding how the business associate will respond to a request for amendment that the business associate receives directly from the individual (such as whether and in what time and manner a business associate is to act on the request for amendment or whether the medical billing business associate will forward the individual’s request to the covered entity) and the time frame for the business associate to incorporate any amendments to the information in the designated record set.]

 

(g) Maintain and make available the information required to provide an accounting of disclosures to the [Choose either “covered entity” or “individual”] as necessary to satisfy covered entity’s obligations under 45 CFR 164.528;

 

[The parties may wish to add additional specificity regarding how the business associate will respond to a request for an accounting of disclosures that the business associate receives directly from the individual (such as whether and in what time and manner the business associate is to provide the accounting of disclosures to the individual or whether the medical billing business associate will forward the request to the covered entity) and the time frame for the business associate to provide information to the covered entity.]

 

(h)  To the extent the business associate is to carry out one or more of covered entity’s obligation(s) under Sub-part E of 45 CFR Part 164, comply with the requirements of Sub-part E that apply to the covered entity in the performance of such obligation(s); and

 

(i) Make its internal practices, books, and records available to the Secretary for purposes of determining compliance with the HIPAA Rules.

  


Permitted Uses and Disclosures by Medical Billing Business Associate

  

(a) Business associate may only use or disclose protected health information

 

[Option 1 – Provide a specific list of permissible purposes.]

 

[Option 2 – Reference an underlying service agreement, such as “as necessary to perform the services set forth in Service Agreement.”]

 

[In addition to other permissible purposes, the parties should specify whether the medical billing business associate is authorized to use protected health information to de-identify the information in accordance with 45 CFR 164.514(a)-(c).  The parties also may wish to specify the manner in which the business associate will de-identify the information and the permitted uses and disclosures by the business associate of the de-identified information.]

 

(b) Business associate may use or disclose protected health information as required by law.

 

(c) Business associate agrees to make uses and disclosures and requests for protected health information.

 

[Option 1] consistent with covered entity’s minimum necessary policies and procedures.

 

[Option 2] subject to the following minimum necessary requirements: [Include specific minimum necessary provisions that are consistent with the covered entity’s minimum necessary policies and procedures.]

 

(d) Medical billing business associate may not use or disclose protected health information in a manner that would violate Sub-part E of 45 CFR Part 164 if done by covered entity [if the Agreement permits the business associate to use or disclose protected health information for its own management and administration and legal responsibilities or for data aggregation services as set forth in optional provisions (e), (f), or (g) below, then add “, except for the specific uses and disclosures set forth below.”]

 

(e) [Optional] Business associate may use protected health information for the proper management and administration of the business associate or to carry out the legal responsibilities of the business associate.

 

(f) [Optional] Business associate may disclose protected health information for the proper management and administration of business associate or to carry out the legal responsibilities of the business associate, provided the disclosures are required by law, or business associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies the medical billing business associate of any instances of which it is aware in which the confidentiality of the information has been breached.

 

(g) [Optional] Business associate may provide data aggregation services relating to the health care operations of the covered entity.

  

Provisions for Covered Entity to Inform Medical Billing Business Associate of Privacy Practices and Restrictions

  

(a) [Optional] Covered entity shall notify business associate of any limitation(s) in the notice of privacy practices of covered entity under 45 CFR 164.520, to the extent that such limitation may affect business associate’s use or disclosure of protected health information.

 

(b)

[Optional] Covered entity shall notify medical billing business associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her protected health information, to the extent that such changes may affect business associate’s use or disclosure of protected health information.

 

(c) [Optional] Covered entity shall notify business associate of any restriction on the use or disclosure of protected health information that covered entity has agreed to or is required to abide by under 45 CFR 164.522, to the extent that such restriction may affect business associate’s use or disclosure of protected health information.

  

Permissible Requests by Covered Entity

  

[Optional] Covered entity shall not request medical billing business associate to use or disclose protected health information in any manner that would not be permissible under Sub-part E of 45 CFR Part 164 if done by covered entity. [Include an exception if the business associate will use or disclose protected health information for, and the agreement includes provisions for, data aggregation or management and administration and legal responsibilities of the business associate.]

  

Term and Termination Of This Medical Billing Business Associate Agreement

 
 

(a) Term. The Term of this Agreement shall be effective as of [Insert effective date], and shall terminate on [Insert termination date or event] or on the date covered entity terminates for cause as authorized in paragraph (b) of this Section, whichever is sooner.

 

(b) Termination for Cause. Business associate authorizes termination of this Medical Billing Business Agreement by covered entity, if covered entity determines business associate has violated a material term of the Agreement [and business associate has not cured the breach or ended the violation within the time specified by covered entity].  [Bracketed language may be added if the covered entity wishes to provide the business associate with an opportunity to cure a violation or breach of the contract before termination for cause.]

 

(c) Obligations of Medical Billing Business Associate Upon Termination Of Agreement.

 

[Option 1 – if the business associate is to return or destroy all protected health information upon termination of the agreement]

 

Upon termination of this Agreement for any reason, business associate shall return to covered entity [or, if agreed to by covered entity, destroy] all protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, that the business associate still maintains in any form.  The medical billing business associate shall retain no copies of the protected health information.

 

[Option 2—if the agreement authorizes the business associate to use or disclose protected health information for its own management and administration or to carry out its legal responsibilities and the business associate needs to retain protected health information for such purposes after termination of the agreement]

 

Upon termination of this Medical Billing Business Associate Agreement for any reason, business associate, with respect to protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, shall:

 

1. Retain only that protected health information which is necessary for business associate to continue its proper management and administration or to carry out its legal responsibilities;

 

2. Return to covered entity [or, if agreed to by covered entity, destroy] the remaining protected health information that the business associate still maintains in any form;

 

3. Continue to use appropriate safeguards and comply with Sub-part C of 45 CFR Part 164 with respect to electronic protected health information to prevent use or disclosure of the protected health information, other than as provided for in this Section, for as long as business associate retains the protected health information;

 

4. Not use or disclose the protected health information retained by business associate other than for the purposes for which such protected health information was retained and subject to the same conditions set out at [Insert section number related to paragraphs (e) and (f) above under “Permitted Uses and Disclosures By Business Associate”] which applied prior to termination; and

 

5. Return to covered entity [or, if agreed to by covered entity, destroy] the protected health information retained by business associate when it is no longer needed by business associate for its proper management and administration or to carry out its legal responsibilities.

 

[This medical billing business associate agreement also could provide that the business associate will transmit the protected health information to another business associate of the covered entity at termination, and/or could add terms regarding a business associate’s obligations to obtain or ensure the destruction of protected health information created, received, or maintained by subcontractors.]

 

(d) Survival.  The obligations of business associate under this Section shall survive the termination of this Agreement.

  

Miscellaneous [Optional]

  

(a) [Optional] Regulatory References. A reference in this Medical Billing Business Associate Agreement to a section in the HIPAA Rules means the section as in effect or as amended.

 

(b) [Optional] Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law.

 

(c) [Optional] Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules.

  

(End Of Medical Billing Business Associate Contract Sample)

 
 

Now that we have completely covered the topic of contracts, it’s time we move on and discuss:

 
 

What goes into marketing your medical billing business

 
 

I really enjoyed sharing with you today and I hope you learned why you Should Never copy medical billing contracts you find online and use them “As Is” for your business!

 
 

  Here’s To Your Success!

 
 
 
 

External Medical Billing Contracts Resources:

 

Sample Billing Contract Drawn Up By MBA Medical Billing

 

Medical Billing Business Contracts Ebook – Authors Review On Youtube

 
 
 
 
 
 
 

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This entire website is copyrighted © and all rights are reserved by Paul G. Hackett, MedicalBillingBizHQ.org & The Samples Of Medical Billing Contracts – Medical Billing Agreements webpage

 
 
 

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