This is an agreement between a medical coding and billing services company and a
healthcare provider for a third party company to exclusively provide coding and billing
services in exchange for a percentage of the hospital’s gross income. The agreement
requires the hospital to provide the company with the information necessary to process
the claims and that the company will quickly process and submit the claims to insurance
companies and individuals. The agreement also requires the company to provide
reports to the hospital and keep the client data confidential. This document contains
both standard clauses as well as opportunities for customization to ensure that the
understandings of the parties are properly set forth.
SERVICE AGREEMENT
THIS SERVICE AGREEMENT (the “Agreement”) made as of ___________ [Instruction:
Insert Date], by and between ___________ [Instruction: Insert Name of Medical Coding and
Billing Company], ___________ [Instruction: Insert Address] (“Company”), and
___________ [Instruction: Insert Name of Hospital], ___________ [Instruction: Insert
Address] (“Client”).
WHEREAS, Company is a healthcare coding, claims and billing service company which
provides computerized claims, billing and collection services to healthcare providers; files
medical insurance claims on behalf of healthcare providers with government and commercial
companies; and provides for billing services directly to patients; and
WHEREAS, Client is a healthcare provider that desires to retain Company to provide it with
coding, claims and billing services;
NOW, THEREFORE, in consideration of the promises and other good and valuable
consideration set forth, the parties agree as follows:
1. Term. The term (“Term”) of this agreement shall commence upon complete execution
hereof and shall continue for one (1) year. Thereafter, the Term shall automatically renew for
successive one (1) year intervals, unless terminated by either party upon thirty (30) days’ prior
written notice.
2. Company’s Services.
A. Throughout the Term, Company will code and 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 Company all information necessary to properly
process the Client's claims and to submit all such billing and insurance information to Company
on a daily basis. Said submissions shall be either be via email with scanned copies being sent to
Company at ___________ [Instruction: Insert Email Address] or via facsimile, with copies
being faxed to Company at ___________ [Instruction: Insert Fax Number]. Company will
process and submit all Client’s claims within ___________ (___) [Instruction: Insert Amount]
hours of its receipt by electronic means wherever possible, and by paper means otherwise.
B. Throughout the Term hereof, Company shall provide to Client the following reports
regarding the Client’s practice, on the following intervals:
i. Insurance Aging Report – ___________ [Instruction: Insert Interval; i.e. weekly,
month, quarterly, semi-annually, or annually]
ii. Patient Aging Report – ___________ [Instruction: Insert Interval]
iii. Practice Analysis – ___________ [Instruction: Insert Interval]
iv. ___________ [Instruction: Insert Type of Report] -- ___________ [Instruction:
Insert Interval]
C. During the Term of this Agreement, Client will not use the services of any other claims
processing and/or bill and service company and will allow Company to process all of the Client's
medical insurance claims with the government and commercial companies.
3. Compensation.
A. Upon execution hereof, Client will pay Company a one-time administrative fee in the
amount of ___________ Dollars ($_____) [Instruction: Insert Amount] (the “Administrative
Fee”). The Administrative Fee shall cover the cost of gathering information from the Client and
setting up the Client's files for entry into computer system for coding and billing.
B. In consideration of Company’s services hereunder, Client will pay to Company a service
fee in the amount of ___________ percent (___%) [Instruction: Insert Percentage] of the gross
income collected by Client from all insurance companies and patients, with a monthly minimum
of ___________ Dollars ($_____) [Instruction: Insert Amount] (the “Service Fee”). Company
will invoice the Client for its services on the 15th day of each month for the previous month's
processing. Within Fifteen (15) days of receipt of said invoice, Client will (i) pay Company the
Service Fee and (ii) provide Company with copies of all Explanation of Benefits (“EOB”) forms
received from insurance companies to Company as well as records of payments received directly
from patients from the previous month so that Company can verify that the amount paid by
Client represents the appropriate amount of gross income. In the event that Client fails to make
full payment of the Service Fee within the time set forth herein, Company may charge a late
payment penalty of ___________ percent (___%) [Instruction: Insert Percentage],
compounded [Instruction: Choose One: monthly // annually], on any unpaid balance. Client
shall also be liable for legal or other fees and costs are incurred by Company to collect any past
due amount. In addition, in the event that Client fails to make timely payment of the Service
Fee, Company may, in its sole and absolute discretion and without prejudice to any rights
Company may have against Client, cease to continue to display provide Company’s services
hereunder.
4. Confidentiality. All patient information and data provided by the Client to Company shall be
kept strictly confidential and shall not be disclosed to anyone outside of Company other than to
the extent necessary for Company to process and submit claims for the Client. The parties
hereto agrees that any disclosure of such information and data would cause irreparable damage to
the Client, and in the event of such breach, the Client party shall have, in addition to any and all
remedies at law, the right to an injunction, specific performance or other equitable relief to
prevent the violation or threatened violation of the Company’s obligations hereunder.
5. Claims. Company 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 Company, 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. Company has no authority to and
will not change any of these procedure codes without the express permission and direction of
Client. Client understands that Company is relying entirely on the claims and billing information
supplied to Company by Client in preparing and submitting insurance claims for payment on
behalf of Client. Client represents and warrants 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 Company 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. Client agrees
to indemnify and hold Company harmless for any and all damages or penalties imposed and any
attorney’s fees incurred by Company in defending any such action resulting from Client's failure
to provide truthful and accurate billing and claims information to Company.
6. Miscellaneous.
A. This Agreement constitutes the entire agreement between the parties hereto with respect
to the specific subject matter hereof and supersedes all prior agreements or understandings of any
kind with respect to the specific subject matter hereof.
B. In the event that any provision or part of this Agreement shall be deemed void or invalid
by a court of competent jurisdiction, the remaining provisions or parts shall be and remain in full
force and effect.
C. Any modification to this Agreement must be in writing and signed by the parties or it
shall have no effect and shall be void.
D. This Agreement is binding upon and shall inure to the benefit of the respective
successors, licensees and/or assigns of the parties hereto.
E. The waiver by either party of a breach or violation of any provision of this Agreement
shall not constitute a waiver of any subsequent or other breach or violation.
F. This Agreement shall be governed in accordance with the laws of the State of
_____________ [Instruction: Insert State], applicable to agreements to be wholly performed
therein, with jurisdiction exclusive to the Federal and State courts located in the County of
_____________ [Instruction: Insert County], State of ______________ [Instruction: Insert
State].
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IN WITNESS WHEREOF the parties have duly executed this Agreement as of the date first
written above.
COMPANY:
________________________________ [Instruction: sign]
By: ___________________________ [Instruction: Insert Name of Signatory]
Title: ___________________________ [Instruction: Insert Title of Signatory]
CLIENT:
________________________________ [Instruction: sign]
By: ___________________________ [Instruction: Insert Name of Signatory]
Title: ___________________________ [Instruction: Insert Title of Signatory]
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