Effective Date: [Insert Date]
Provider: [Your Company Name], hereafter referred to as “Billing Company”
Client: [Healthcare Provider Name], hereafter referred to as “Client”
The Billing Company agrees to provide medical billing services including, but not limited to:
Claims preparation and submission to insurance companies
Patient billing and statement generation
Payment posting and reconciliation
Follow-up on denied or unpaid claims
Reporting of financial and billing activity
The Client agrees to:
Provide accurate and complete patient demographic, insurance, and clinical data.
Respond to information requests from the Billing Company in a timely manner.
Maintain appropriate licensure and credentials to provide medical services.
Comply with all applicable healthcare laws and regulations.
The Client shall pay the Billing Company [insert fee structure – e.g., percentage of collected revenue or flat monthly fee].
Invoices shall be issued monthly and are due within [e.g., 15] days of receipt.
Late payments may incur a [e.g., 1.5%] monthly interest fee.
This agreement shall begin on the Effective Date and remain in effect until terminated by either party with [e.g., 30] days written notice.
Either party may terminate immediately for breach of contract or violation of applicable laws.
The Billing Company agrees to maintain the confidentiality of all patient information in compliance with HIPAA and other applicable privacy laws.
A separate Business Associate Agreement (BAA) shall be executed to ensure HIPAA compliance.
The Billing Company shall not be liable for errors resulting from incorrect or incomplete information provided by the Client.
The Client agrees to indemnify and hold the Billing Company harmless from any claims, damages, or legal expenses resulting from the Client’s actions or omissions.
Any disputes shall first be resolved through good-faith negotiations.
If unresolved, disputes may be submitted to mediation or arbitration in the jurisdiction of [insert location].
No amendment to this agreement shall be valid unless in writing and signed by both parties.
No amendment to this agreement shall be valid unless in writing and signed by both parties.
As a member of AMB you will receive a customized billing process tailored to your needs. Call us today and receive a discount for becoming a part of this team.