1. Modelos
  2. Medical Billing Contract

Medical Billing Contract

Utilizado 4,872 vezes

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  1. Modelos
  2. Medical Billing Contract

Medical Billing Contract

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Created by:



Prepared for:



Associated Medical Establishment:


Medical Establishment Address:


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.

Medical Billing Services

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.

Client Responsibilities

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.

Service Provider Fees

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.

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.

HIPAA and Confidentiality

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.

Term and Termination

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.

Limitations of Liability and Warranty

Client hereby agrees to hold harmless and indemnify the Service provider and its affiliated parties and individuals from and against all liability, claims, damages, fines, penalties, and responsibilities arising from the performance and nonperformance of this Contract. No party shall be held liable for special, incidental, indirect, or consequential damages.

Submitting false information, claims, misleading data, or fraudulent information to third-party payors or the government is a crime. Neither Party will incur liability for failing to perform any contractual obligations if the failure results from a force majeure event or any other force beyond their reasonable control.

Final Agreement

The laws of [ServiceProvider.State] govern this Contract and constitute the agreement between both Parties. It supersedes all previous verbal and written agreements.

IN WITNESS WHEREOF, the Parties execute this agreement on the below date by adding their signatures to this document, and they acknowledge and understand all terms contained within the Contract.





Medical Billing Contract

Utilizado 4,872 vezes

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