General terms
This Agreement (“Agreement”) dated (“Effective Date”) between Medical Office Force LLC, with its primary business address at 2005 Prince Ave, Athens, GA 30606, hereinafter referred to as the “Contractor Company” and (“Company name listed in signature document”) having its primary business address at (Address listed in Signature document) hereinafter referred to as the “Client”. The Contractor Company and Client each can be referred to as a “Party” and collectively as the “Parties”.
TERMS & RENEWAL
- This Agreement is in effect for Two (2) years from the Effective Date Notwithstanding the foregoing, either Party may terminate immediately upon written notice in the event of a material breach of this Agreement by the other Party. The termination notice MUST be served upon the receiving party via certified mail or fax. If termination is for other reasons without any material breach, then Sixty days (60) days prior written notice is mandatory.
- This Agreement immediately renews on a month-to-month basis upon the Two (2) years initial period being completed (“Renewed Period”). During the Renewed Period, Sixty (60) days’ written notice is required for termination. All the applicable terms and conditions of this Agreement will apply until the parties either terminate the Agreement or execute a new agreement.
CONFIDENTIALITY
The Contractor Company understands that the Client’s information concerning the CLIENT and its customers, including personal and financial information, is sensitive and confidential. The Contractor Company will abide by all confidentiality guidelines as per HIPAA regulations and will sign the Business Associate Agreement in the form attached hereto. The Contractor Company agrees not to disclose any confidential information without expressed written permission from the CLIENT’S office. The Contractor Company is not responsible for incorrect information provided by the CLIENT and/or its staff.
USE OF INFORMATION
- When submitting claims and/or statements, The Contractor Company is acting in good faith and represents the CLIENT’S office in all forms of communication. CLIENT hereby appoints and designates the Contractor Company as its agent for the limited purpose of providing the Services to the CLIENT. The Contractor Company has the CLIENT’s express permission to settle claims, and disputes, answer phone calls from carriers and patients/guardians using the name of the CLIENT’s office within the telephone conversation, place the CLIENT’s name on bills and letters pertaining to the unpaid debt of the patients. The CLIENT also gives The Contractor Company express permission to sign as a representative of the CLIENT’s office.
- The Contractor Company will not make any changes to medical records that are insufficient for medical coding or billing, copies of explanation of benefits (EOB’s) or any other documents received from carriers, patients or other sources. The Contractor Company will not become involved in carrier contract violations or disputes. The CLIENT takes complete responsibility of this and will indemnify the Contractor Company from disputes arising from such situations. The Contractor Company will retain all medical billing software licenses and may give access to the CLIENT for a reasonable user access fee as may be applicable at the time.
- The Contractor Company and its employees shall at all times be independent Contractor Company and not employees of the CLIENT. The CLIENT shall have no authority to bind the Contractor Company .
USE OF INFORMATION
- When submitting claims and/or statements, The Contractor Company is acting in good faith and represents the CLIENT’S office in all forms of communication. CLIENT hereby appoints and designates the Contractor Company as its agent for the limited purpose of providing the Services to the CLIENT. The Contractor Company has the CLIENT’s express permission to settle claims, and disputes, answer phone calls from carriers and patients/guardians using the name of the CLIENT’s office within the telephone conversation, place the CLIENT’s name on bills and letters pertaining to the unpaid debt of the patients. The CLIENT also gives The Contractor Company express permission to sign as a representative of the CLIENT’s office.
- The Contractor Company will not make any changes to medical records that are insufficient for medical coding or billing, copies of explanation of benefits (EOB’s) or any other documents received from carriers, patients or other sources. The Contractor Company will not become involved in carrier contract violations or disputes. The CLIENT takes complete responsibility of this and will indemnify the Contractor Company from disputes arising from such situations. The Contractor Company will retain all medical billing software licenses and may give access to the CLIENT for a reasonable user access fee as may be applicable at the time.
- The Contractor Company and its employees shall at all times be independent Contractor Company and not employees of the CLIENT. The CLIENT shall have no authority to bind the Contractor Company .
DISPUTES & DAMAGES
- The Contractor Company will make every effort to perform its obligations in accordance with industry standards. However, when disputes arise between the Contractor Company and the CLIENT’S office, Parties will first make reasonable attempts to resolve them in good faith amicably. Unresolved disputes shall be governed by the Rules of the American Arbitration Association specific to the State of Georgia and shall be binding upon both parties.
- Other than as set forth expressly herein, all other warranties, express or implied, with respect to all hardware, software or services provided to CLIENT under this Agreement, including but not limited to, any warranty as to merchantability or fitness for any particular purpose, noninfringement, utility, functionality or suitability for its intended purpose, are hereby disclaimed.
FORCE MAJEURE
The Contractor Company shall not be held liable for failure to provide services in the event of force majeure, including not limited to natural disasters, war, major upheavals, fire, and performance failures out of its control (i.e. disruptions in online or telephone services attributable to online or telephone service providers).
DISCLAIMER & INDEMNIFICATION
- The Parties acknowledge and agree that the Contractor Company provides medical billing services only and will not assist the CLIENT with any other medical matters. All documentation (i.e. fee superbills, patient demographics, release forms, etc.) is ultimately and entirely the CLIENT’S responsibility. The Contractor Company warrants that its billing will be based strictly on the information provided by the CLIENT. The Contractor Company shall not be responsible for incorrect information provided by the CLIENT’s office and/or staff.
- CLIENT shall indemnify, defend and hold harmless the Contractor Company against (i) all liability cost, loss, or expense arising out of or resulting from (i) violations of state or federal regulations by the CLIENT, or (ii) CLIENT’s provision of inaccurate, incomplete or incorrect data to the Contractor Company. CLIENT further agrees to furnish all legal defenses reasonably necessary for the Contractor Company in any state or federal legal proceeding.
MISCELLANEOUS
- Assignment. The Agreement may not be assigned by CLIENT, except with prior written consent by the Contractor Company.
- Changes in Laws and Regulations. Notwithstanding any other provision of this Agreement, if federal, state or local governmental agencies (or their representatives), issue or promulgate any law, rule, regulation, standard or interpretation at any time, while this Agreement is in effect, which prohibits, restricts, limits, or in any way materially changes the method or the method or amounts of reimbursement or payment for services rendered under this Agreement, or which otherwise materially affects either Party’s rights or obligations hereunder, then either Party may give the other Party notice of intent to amend this Agreement in a fashion that is equitable to each Party considering such prohibition, restriction, limitation or change, and the parties shall negotiate in good faith to accomplish such amendment. If this Agreement is not so amended in writing within Thirty (30) days after such notice is given, either Party shall have the right to terminate this Agreement as of midnight on the seventy-fifth (45th) day after said notice to amend is given unless otherwise agreed; provided, however, that if a formal appeal is filed with the relevant government agency or a suit is filed in a court of competent jurisdiction, by either Party, so as to stay the implementation of any such law, rule, regulation, standard or interpretation, during the period of such stay, the right to amend as set forth above shall also be stayed.
- Entire Agreement: Modification and Change. This Agreement and all exhibits and attachments hereto contain the entire agreement between the Parties with respect to the subject matter of this Agreement and supersede any and all prior agreements, arrangements, representations or understandings between the Contractor Company and the CLIENT relating to the subject matter of this Agreement.
- Severability. If any provision of this Agreement or its application to any person or circumstance shall be invalid or unenforceable to any extent, the remainder of this Agreement and the application of its provisions to other persons or circumstances shall not be affected and shall be enforced to the greatest extent permitted by law.
- Rights Cumulative: No Waiver. No right or remedy in this Agreement conferred upon or reserved to either Party is intended to be exclusive of any other right or remedy, and each right and remedy shall be cumulative and in addition to any other right or remedy given under this Agreement, or hereafter legally existing upon the occurrence of any event of default under this Agreement. The failure of either Party to insist at any time upon the strict observance or performance of any of the provisions of this Agreement will not constitute a waiver of the right to demand exact compliance with the terms hereof.
- Construction. In the event of any conflict between the terms, conditions, and provisions of this Agreement and those of any other document referred to herein, the terms, conditions, and provisions of this Agreement shall control.
- Counterparts. This Agreement may be executed simultaneously in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument
Client Responsibilities
- Within seven (7) business days of signing this Agreement, CLIENT will provide:
- Complete Provider Registration Form & Current PMS and EMR Admin access.
- Provide the Current Fee Schedule for all CPT codes, If already have.
- Provide legible copies of the following patient information for each new patient:
- Front and back of patient insurance card and/or secondary information card
- Assignment of benefits form
- Patient intake form includes the following: address, phone number, guarantor information, employer name, and address, and signed authorization for release of medical information.
- Provide copies of the following at the close of each day:
- All super bills/fee slips for each day.
- Any and all correspondence from insurance carriers
- Any and all payments received in the office through Contractor Company’ effort only.
- CLIENT will provide a list of patients showing patient/guarantor demographic information, dates of service, charges, payments made by any insurance carrier, copies of EOBs and any other correspondence, medical records, time payment plans established between the patient/guardian and client, and notes made in the account.
- CLIENT will share access to Portals of all Insurance payers to speed up the billing work.
Contractor Company Responsibilities
- Eligibility of all the patients before entering charges.
- Data Entry of all charges for which all the relevant information is provided within 24-48 hours.
- Electronic and/or paper claim submission to insurance carriers.
- Initial Practice Setup: Entering complete information about the provider, lists of insurance carriers, fee schedules, ICD-10, and CPT-4 codes into the software prior to the start of work
- Accurate ICD-10 and CPT coding match-up.
- Persistent follow-up on submitted Aging claims till they are processed and closed.
- Denial Handling: Following insurance guidelines for all appeals and pursuing all avenues to receive payments. If the appeal process has been exhausted, forward the information back to the CLIENT for review and analysis.
- Posting of payments received from insurance companies and patients.
- Monthly Patient statement printing and mailing.
- The Contractor Company will process billing statements in 30 days’ cycle.
TERMS & CONDITIONS
Contractor Company shall submit invoices to the CLIENT on successful completion of the above process. CLIENT shall pay the Contractor Company no later than seven (7) days after receipt of each invoice. If not paid after 7 days, the invoice will incur 2% interest per month.