Medical Billing Contract : How To Save A Bundle In Attorney Fees

A medical billing contract between your billing service and the health care provider is basically a summary of the expectations and responsibilities of both parties. The better job you do communicating and clarifying the medical billing service agreements through your written contract, the less likely you'll have an unhappy client or possibly even a lawsuit.

Since most attorneys charge by the hour, you could save some real money if you have an idea of what you would like in your billing agreement when you meet with your attorney to review or prepare your contract. And yes,­­ even if you know exactly what you want your medical billing agreement to contain, you should still plan to meet with an attorney.

A word of caution; if you are tempted to search the internet for a "sample contract" and just put your name on it, we strongly recommend that you reconsider. In fact, when writing this page, we deliberately did NOT put a sample contract on this page even though we could have—it’s really not in your best interest.

No two medical billing companies are alike any more than any two health care providers are. Each of your clients will have different needs and those special needs and expectations should be reflected in their contract. If you are ever sued or have a doctor who does not pay you for services rendered, you will surely wish you had invested a little more time and money preparing a unique medical billing contract that was reviewed by your attorney to protect your business.

Like any relationship, there’s a honeymoon period. You’ve signed the contract and the doctor loves you because you’ve helped streamline their billing process and the checks are starting to come in quicker and the AR’s are shrinking. BUT what happens if the money starts to slow because his new office manager is no longer following the procedures you had suggested? What if the provider wants to terminate the contract early since he got a “low ball “ offer from your competitor? What if the doctor has suddenly become a nightmare to work with and is making unreasonable demands for services you had not originally agreed to? These are just a few of the reasons having a well thought out contract is so important.

You will need help determining what should be included in any contract to be sure you cover all the pertinent points and make sure all issues which should arise are addressed. A great ebook to help you is Write a Kick Butt Contract For Your Medical Billing Service! This book will give you the facts to enable you to create a solid billing contract.

Write a Contract For Your Medical Billing Service

This book, written by a mother and daughter team, who have run a successful medical billing business for over two decades, will give you the facts to help you to create a solid billing contract for your own unique needs and protection. This ebook contains over 80 pages covering all aspects of the medical billing agreement as you would expect by the title. But it also contains a wealth of other helpful info including: Pricing, compliance issues, professional liability errors & omissions insurance, and more...

What Should Be Included In Your Medical Billing Contract?

Many topics you'll want to cover in your medical billing contract will be based on your healthcare provider’s specialty and the unique services provided to the practice. A good place to start is to picture what a successful medical billing business relationship would look like, then make sure everything in your contract helps this become a reality. Next, you want to think of everything that could go wrong and detail how it will be handled if a dispute should arise.

Some of the things you should consider including in your medical billing contract are:

  • How and when you will be paid (percentage billing VS flat fee VS hourly rate)
(Click here to get more information about Pricing Your Medical Billing Service)
  • What services you will provide
  • What do you expect from the provider (example: You will be the exclusive billing service for the length of the contract)
  • Reporting requirements: Does the Doctor want daily, weekly, or monthly reports?
  • Length of the contract or service agreement: Should you go month to month or try to get a yearly agreement? You obviously want to keep the good clients for as long as you can but what if you get that one nightmare doctor that you wouldn’t even wish on your biggest competitor? (Click here to learn whether a month to month contract or long term medical billing contract is best)
  • Termination process: This section needs to contain more than just the common courtesy of a 30 or 60 day notice before the renewal date. The bigger issue that very few billing companies think of, is how long are you willing to keep working (following up) on claims you’ve billed before the termination date but have not paid yet?
  • Confidentiality in order to comply with HIPAA (See “Business Associate Agreement” below)
  • Liability of errors
  • Hold harmless agreements
  • Arbitration agreement
  • Set up fee: Every billing service would love to get a big upfront fee but be careful not to charge so much that you don’t get the account. There are even times that it has made sense for us to completely waive our set up fees.
  • Minimum monthly fee (this may be a big negative for a new medical provider)
  • How many patient bills will the billing service be required to send out before another action is taken such as sending account to collections. Typically 3 to 4 would be considered reasonable.
  • Do insurance EOB's and patient payments go the billing company (lock box) or the medical provider?
  • Both parties are typically acting as independent contractors and should not be considered as employees.
  • Whether the billing company is permitted to subcontract to third parties such as overseas insurance claims processors. Most providers we have dealt with do not want their billing information being handled overseas.

Business Associate Agreement

Medical providers should require that you sign a Business Associate Agreement to comply with the HIPAA Privacy Rules. This documents that a covered entity (the Provider) has an agreement with the business associate (Medical Billing Service in this case) to comply with the requirements of the HIPAA Privacy Rule.

The U. S. Department of Human Services has a more detailed overview as well as a Sample Business Associate Agreement that you may want to use.

It would be nearly impossible for your medical billing contract, or any service agreement, to cover every dispute that could ever arise. But with the help of the above mentioned resource and competent legal counsel you should be able to prepare a contract that anticipates the most typical problems that might arise. And it should go without saying that you should always have any medical billing contract reviewed by your attorney.

› Medical Billing Contract

Disclosure: Compensated Affiliate.You should assume that the owner of this website has an affiliate relationship and/or another material connection to the providers of goods and services mentioned on this website and may be compensated when you purchase from a provider. You should always perform due diligence before buying goods or services from anyone via the Internet or offline. Click here for more information.

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