Updated July 30, 2020:

A medical billing services contract is essential in any medical billing service. If you work from a home-based billing service, a contract needs to carefully outline what you provide, your fees, when they are to be paid, and other pertinent information to ensure everyone involved gets what they are entitled to.

Medical Billing Contract

Contracts are very crucial for medical billing professionals. They define the roles and responsibilities of all parties while also outlining what is provided, the price, and the like. It needs to also describe the responsibilities of the client and the billing specialist.

A good medical contract is important if you are a medical biller with a home business. The following are some pertinent questions you should ask yourself when you’re a medical billing professional:

  • What happens if the client does not provide you with the information required to do your job?
  • What if you do not have the EOBs needed to post your payments?
  • What if your client expects extra services you did not want to provide?

With a good contract, you can avoid any possible problems. You will need to review it carefully with your client. It is important to provide the services that you promise, but you also need to be paid for your work and your expenses.

You also need to outline the deliverables and any responsibilities if you stop providing your services.

Contract Terms to Look for in Your Written Agreement

Once you and your client have agreed on a price, you need to formalize it with a written contract. It should include the mutually agreeable terms and needs to outline what you are both responsible for, including:

  • Responsible parties - the names of the parties that are involved, the name of your business, and your client’s name. The incorporated names are required if your business is incorporated.
  • Effective dates - this shows the date when the contract is effective. If it is a short-term contract, you need to indicate the expiration date.
  • Reimbursement-  this is crucial in medical billing contracts. You will explain your fees when they are due, what happens if they are late paying or do not pay, and late fees. This rate can be calculated using a per claim basis or as a percentage of your receipts. If you terminate the contract, you need to include how you will be paid.
  • Responsibilities of your client - the client will be responsible for providing you with certain information, such as patient demographics, insurance identification, EOBs, and patient payments. This information needs to be accurate and provided upon request.
  • Who completes the coding - your contract needs to name who will be doing the coding ahead of the work start date. Some health providers do their own coding while others do not. If the client would like the medical billing service to do the coding, all chart notes have to be provided promptly. The staff also has to be qualified to do this type of work.
  • Who receives the insurance and patient payments - some doctors will have payments go straight to the billing service. The client is responsible to make sure you get copies of all the payments.
  • Medical billing service responsibilities - the medical billing services will provide the processing of claims, follow-ups, patient statements, cash charges, reports, and other duties as required. A time frame is included for processing claims. You can outline this information in a Statement of Work, which is a different document.
  • Termination - this lists how the term of the agreement will end, such as in a year, a month, etc. It will need to include starting and ending dates. A doctor may want to automatically renew each year rather than getting into a new agreement. However, either party can terminate whenever they like within a certain time frame. A contract needs to list that all confidential information needs to be returned to the client if it is terminated.
  • Software compatibility - the agreement needs to include that the billing company uses software that can handle many fee schedules. It also needs to be capable of allowing information to be transferred to another system if the billing contract is terminated.

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