GINA CONSULTING DONE FOR YOU MEDICAL BILLING TERMS OF SERVICE
TERMS OF SERVICE AND PRICING
By engaging the Services of Gina Consulting Corporation, located at 9393 N 90th St, Suite #102-659, Scottsdale, AZ 85258, referred to as “Billing Center”, or by clicking “I Agree” below, you, hereby referred to as “Provider” or “Client”, agree to the following Terms of Services as set forth herein.
These Terms of Service shall be in effect as of the date of acceptance and shall supersede any and all prior agreements between Billing Center and Provider, if any. Any Provider who engaged Billing Center prior to January 1, 2023, shall be given notice of these new Terms of Service but shall not be required to complete or execute any portion of these Term of Service as described in Section 20 of the prior Medical Billing Agreement.
Billing Center agrees to provide services or continue to provide services to Provider designed to effectuate the filing of Medical insurance claims with governmental authorities and private commercial carriers through electronic and manual means (Claims Processing), and also offers direct billing services to the patient (Billing Services).
Provider desires to engage or continue to engage Billing Center to provide Claims Processing and/or Billing Services as set forth herein.
The parties agree as follows:
1. BILLING CENTER RESPONSIBILITIES:
A) Insurance Claims Processing: Billing Center will file, process, follow up and collect Provider’s claims as requested by the Provider. The claims will be processed within 3 business days, excluding those that contain errors for which billing service has received inadequate or incorrect information, from the date of receipt at Billing Center. Billing Center will request corrected information from Provider, in a timely matter, upon the realization that any claim is un-processable.
B)Billing Center agrees that it will complete all follow-up work until all claims are finally adjudicated by the insurance payer and ether paid or deemed not payable to Provider.
C)Billing Center agrees that it will provide payment posting for all payments including insurance and patient payments within the Billing Center software system(OpenPM).
D)Billing Center will grant Provider and its employees online, 24/7 access to Billing Centers software 30 days after contract signing.
E)Billing Center will configure all account set up including but not limited to EDI, ERA, EFT, Fee Schedules, addresses and locations, and Provider database, given that Provider furnishes all necessary information.
F)Billing Center will furnish Provider with regularly generated financial and practice reports on a monthly and yearly basis.
G)Patient Billing Services: Billing Center will generate statements to patients that have a balance remaining after insurance payments and adjustments are posted. Statements are generated in PDF and sent electronically FREE to the Provider on a monthly basis. If Provider prefers that Billing Center mails patient statements directly to patients, an additional fee per statement applies as stated under item 3.
H)Billing center will conduct quarterly internal audits of it’s work to ensure the quality and accuracy of the work.
2. PROVIDER RESPONSIBILITIES:
A)Provider agrees to provide information necessary to allow Billing Center to effectively process insurance claims. This includes information regarding patients including diagnosis, procedures, full demographic, and their insurance information & coverage. Billing Center shall not be responsible for any delay in or inability to collect claims due to insufficient or inaccurate information provided by the provider or his/her staff. Provider agrees to submit any and all potential insurance claims to billing center for all encounters and will not submit claims directly to insurance companies or through any other service for the entirety of this agreement.
B)Provider agrees to provide billing information to Billing Center daily or once a week at a minimum. Provider agrees to transmit billing information directly to the Billing Center via direct access to provider software, fax, or through a secure online document sharing center.
C)The Provider will be responsible for verifying that the patient charges are correct and reflect the services performed on the date of service.
D)Provider shall make every effort to collect patient co-pays and deductible payments at time of service and report such payments to Billing Center.
E)The Provider agrees to furnish copies of all explanation of benefits(EOB) and explanation of payments(ERA/RA) received directly by the provider or any of it’s offices and location, directly to the billing center within 1 week of receipt of such documents. This includes any paper documents and any electronic communications containing information of claims or payments for claims.
3. PROVIDERS’ PAYMENT FOR SERVICES:
There are no initial setup fees unless otherwise agreed upon and outlined in Exhibit C. Medical Billing Fees may include the following services: Claim submission, follow up with insurance companies, generating patient statements, posting payments, and generating reports. All applicable fee are listed hereafter.
Fees for CURRENT CLAIMS:
Provider Agrees to the following tiered pricing based on monthly collected amount:
Less than $25,000/month = 8%
$25,000-$50,000/ month 7%
$50,000-$100,000/ month = 6%
$100,000-$250,000/ month = 5.5%
Over $250,000/ month = 5%
Monthly Minimum = $100
The monthly collected amount will be determined based on all payment posted during the given month. Billing Center will determine the "tier" at the beginning of this contract based on information furnished by Provider. If during the course of the agreement the collection amount moves to a different tier Billing Center will adjust the monthly invoice to that tier. The entire amount collected in any given month will be considered under one tier only. Any claims submitted to the Billing Center in a non-standard file format will incur an additional processing fee of 2% per claim.
The total monthly amount collected by Billing Center shall include all direct insurance payments posted during the given month as well as patient payments such as co-pays, coinsurances, and deductibles collected at the time of service, insurance payments, and patient payments made towards any claim billed by the Billing Center.
Failure of the Provider to report patient payments will result in the total monthly collected amount to be calculated based on the total allowed amount for all insurance claims payments posted during the given month and Provider hereby agrees to indemnify Billing Center for any and all damages or liability attributed to Provider’s failure to report patient payments.
In addition, Provider agrees to pay Billing Centers’ fees for the following additional service, whereas Provider must have requested these services and thereby approved their rendering.
Eligibility = $0/ per request: Eligibility request will specify either an active or inactive patient insurance policy for the type of service and date of service specified by the provider. Billing Center is only responsible for the accurate reporting of such information, however in reporting this information Billing Center makes no guarantee of payment or coverage representation to the provider.
Coverage Determination = $7.50/ request: Coverage determination will specify patient benefit amount, copay, deductible, co-insurance, and the need for prior-authorization for the services specified by the provider for a specific date(s) of service. Billing Center is only responsible for the accurate reporting of such information, however in reporting this information Billing Center makes no guarantee of payment or coverage representation to the provider.
Prior Authorization $25/ request: Prior-Authorization can only be obtained by Billing Center on behalf of the Provider if the provider furnishes all necessary information for the billing center to complete the request. Approval of service gained through a prior-authorization from an insurance payer is not a guarantee of payment, neither by the billing center nor the insurance payer.
Fees for OLD CLAIMS:
For claims 60-days and older that existed prior to the execution of this agreement and Provider wishes to assign to Billing Center to collect, Provider agrees to pay Billing Center the following fees: The sum of 15% of all collections associated with the collection on such claims, provided these claims were determined to be outstanding
Billing Center will supply three (3) consecutive monthly statements to patients that have outstanding patient responsibility balances. Statements are generated in PDF and sent electronically FREE to the Provider on a monthly basis. If Provider prefers that Billing Center mails patient statements directly to patients, the cost per patient statement will be $0.85. Use of Billing Services' online payment portal will require that Provider opens a new merchant account with Billing Centers payment portal service partner and completes the merchant account form.
Patient accounts will be turned over to the Provider’s office if the account is not in good standing after three (3) consecutive monthly statements.
If Provider wishes to pursue patient collection efforts beyond the standard 3 monthly statements Billing Center can engage in a soft-collections effort on behalf of the Provider. Whereas this effort is to include 2 telephone calls and 3 mailed collection letters. In engaging this service Provider understands that Billing Center does not guarantee payment of the outstanding patient balance as a result of this effort. Provider must consent to any such collection effort. Provider further agrees to pay Billing Center a fee of $25 for each such effort.
INVOICING FOR SERVICES:
Billing Center will invoice Provider at the beginning of each month for the previous month’s services. Remittance of these charges will be due in full within 15 days. A late fee of $25 will be added to invoices that are not paid by the due date. If Provider is behind by more than 30 days on payment to Billing Center, the Billing Center reserves the right to hold insurance claims and reports until the account is paid in full. All invoices are final and will not be revised. Any inaccuracy or dispute of charges having been found credible by both parties shall be reflected on the following invoice.
Billing Center requires a credit card or bank account on file for the Provider as specified in Exhibit C of this document. The full invoice amount will be charged upon the issuance of the invoice via the payments method on file. In the event that the Provider’s payment method is declined then a fifteen (15) days grace period shall commence whereby the Provider shall not be charge any late fee or interest. If the full invoice is not paid within fifteen (15) days from the issuance of the invoice, then Billing Center shall have the option to charge a 1.5% per month late fee on the total amount owed to Billing Center .
EARLY TERMINATION FEE:
Billing Center agrees that no early termination fee shall be charged to the Provider.
4. DESIGNATION OF BILLING CENTER AS PROVIDER’S AUTHORIZED AGENT:
Provider hereby appoints and designates Billing Center as it’s an agent for the limited purpose of billing and corresponding with insurers regarding procession and collection of insurance claims, and any insurer or payor of claims is authorized to rely upon this written delegation of authority in its dealings with Billing Center as the agent of Provider for this limited purpose. Provider hereby agrees that the Billing Center can act on Providers behalf to complete any Electronic Funds Transfer, Electronic Remittance Advice and Electronic Data Interchange agreements, enrollments, payer or clearinghouse setup required in order for Billing Center to complete claims processing, posting and follow-up work.
5. RELATIONSHIP OF THE PARTIES:
Billing Center and its employees shall always be independent contractors and not employees of Provider. Billing Center shall not have any authority to compromise claims or otherwise to bind provider except as expressly set forth above, and Provider shall have no authority to bind Billing Center.
6. TERMS OF AGREEMENT:
This agreement shall be in effect for one (1) year from the date of execution. After the contract period, it shall renew for a new full one (1) year term unless either party submits in writing a desire in a change of terms.
Either party may terminate this Agreement at any time, with or without cause, by giving forty five (45) days' written notice of termination to the other party. At termination, Billing Center shall continue to follow already submitted claims for thirty (30) days and Provider agrees to compensate said fees for these remaining claims. Thirty (30) days past the filing of the final claim, Billing Center will deliver to Provider current insurance aging, patient aging, and service aging reports upon receipt of final payment from the Provider. No further compensation will be due to the Billing Center nor shall Billing Center make further attempts to collect outstanding claims or patient balances.
Upon the termination of this Agreement for any reason, the database created for each Provider shall be furnished by Billing Center at the request of the Provider, within forty (five) days from the date of termination. Billing Center shall provide the data in a standard file format for database transfer.
Billing Center agrees and covenants to keep all information concerning physician and its patients, including personal and financial information, strictly confidential; and Billing Center agrees that it will not disclose any information to any person or a third party, except as may be reasonably necessary to file and process claims and/or send patient statements.
HIPAA Privacy Requirements. Billing Center understands and acknowledges that it may receive from, create or receive on behalf of Provider, Protected Health Information (“PHI”) as defined under the privacy regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), and/or nonpublic personal information, as defined under the Gramm-Leach-Bliley Act and implementing regulations (“GLB”), during the performance of Billing Center’s obligations under this Agreement. Except as otherwise specified herein, Billing Center may use or disclose PHI received from or created or received on behalf of Provider and Provider’s patients, and nonpublic personal information received from or created or received on behalf of Provider and Provider’s patients (“Personal Information”) to perform functions, activities, or services for, or on behalf of, Provider and Provider’s patients as specified in this Agreement, provided that such use or disclosure would not violate the HIPAA privacy regulations, GLB or other federal or state privacy laws applicable to Provider and Provider’s patients, if done by Provider and/or Provider’s patients. With regard to its use and/or disclosure of PHI or Personal Information, Billing Center hereby agrees and represents and warrants to Provider that Billing Center shall:
a. not use or further disclose any PHI or Personal Information other than as permitted by this Agreement or required by law.
b. at all times maintain and use appropriate safeguards to prevent uses or disclosures of any PHI or Personal Information other than as permitted by this Agreement or required by law;
c. ensure that any subcontractor or agent to whom it provides any PHI or Personal Information agrees in writing to the same conditions and restrictions that apply to Company with regard to the PHI or Personal Information, including, without limitation, all of the requirements of this Agreement.
Provider agrees to keep all information concerning Billing Center and its claims processing and Billing Services strictly confidential and agrees that it will not disclose such information to any person or a third party, all of which constitutes proprietary trade secrets of Billing Center. Provider further agrees that it will not use such information for its own benefit or that of any other person or a third party, and that provider shall not compete with Billing Center in any manner, directly or indirectly, in the business of claims processing and/or Billing Services as presently or hereafter carried on by Billing Center.
The foregoing provisions regarding confidentiality shall survive the termination of the agreement. Furthermore, the foregoing provisions constitute
independent covenants and shall not be discharged by any breach or default of the party seeking their enforcement.
8. LIMITATIONS OF LIABILITY:
Billing Center warrants that it shall use its best efforts to file and process medical insurance claims and/or shall bill patients on behalf of Provider in a good workmanlike manner. Billing Center shall use its best efforts to maintain a high professional standard in the execution of its services so as to minimize the possibility of any damage or loss to Provider’s systems and data.
Without in any way limiting the generality of the foregoing disclaimer or warranties, Billing Center makes no warranty or representation whatsoever as to when or if any particular insurance claim will be honored/paid by the insurer.
In the event that Billing Center shall fail to perform its services in a good and workmanlike manner, or shall otherwise perform in a negligent or non-conforming manner, Billing Center agrees to either re-submit the claim or claims in question at no cost to the provider or to refund all moneys paid by provider with respect to such non-conforming services, as Billing Center may in its sole discretion elect. PROVIDER AGREES THAT ITS SOLE AND EXCLUSIVE REMEDY HEREUNDER SHALL BE LIMITED TO A REFUND AS SET FORTH HEREIN. The refunds described herein shall only be made if Billing Center has been compensated for the services rendered.
In no event shall Billing Center be liable for damages or breach due to acts of God, natural disasters, or other matters beyond the reasonable control of Compliant Billing Services.
In no event shall Billing Center be liable to the Provider for any special, indirect, incidental, consequential, punitive or exemplary damages of any nature, including but not limited to loss of profits, loss of business or loss of business opportunity. The foregoing shall apply regardless of the negligence or other fault of Billing Center and regardless of whether such liability sounds in contract, negligence, tort, strict liability or any other theory of liability. In no event shall the maximum amount of damages payable by Billing Center to the Provider for any cause, including but not limited to breach of this Agreement, or the failure or interruption of services, whether in contract, tort or negligence, exceed the total amounts actually paid by Provider to Billing Center hereunder during the period of time that the breach occurs.
The foregoing provisions regarding disclaimers of warranty and limitations upon liability shall survive the termination of these Terms of Service. Furthermore, the foregoing provisions constitute independent covenants and shall not be discharged by any breach or default of the party seeking their enforcement.
9. PROVIDER REPRESENTATIONS AND WARRANTIES.
Provider warrants and represents that all information supplied to Billing Center is true and accurate to the best of Provider’s knowledge. Provider shall not knowingly give information to Billing Center that is fraudulent or false. Provider agrees to hold Billing Center harmless from any liability resulting from violations of state or federal regulations committed by Provider relating to the collection of Provider’s claims, and will actively assist Billing Center in its defense in any such proceeding. Should Billing Center determine that Provider has submitted improper or fraudulent information to Billing Center for submission, Billing Center, in its sole discretion and depending upon the severity of the case, will either assist Provider in mitigating the problem, report the problem to the Office of Inspector General (OIG) or terminate this Agreement immediately, as required by the OIG Third Party Billing Guidelines and Billing Center’s OIG Compliance Plan. For any unpaid amount due by Provider to Billing Center hereunder, then Provider shall immediately pay the amount due with interest from the date due until paid at the rate of 1.5% per month.
10. RECORD KEEPING:
Provider agrees to keep records of all explanation of benefits from insurance companies as required by State law. It is understood Billing Center will dispose of these records after 3 months as the originals must be held by the Provider as required by state laws. Any and all patient information received at Billing Center will also be properly destroyed immediately after data is entered into software program.
11. PAYMENTS TO PROVIDER:
Provider receives payments directly from insurance companies and patients. Billing Center does not and will not offer reconciliation of posted payment against payments received by the provider. Provider is solely responsible for verifying receipt of posted payments.
The Provider has sole control of its bank account.
Billing Center has no access to the funds.
In the event that any term or provision of this Agreement is held to be illegal, invalid, or unenforceable under the laws, regulations, or ordinances of any federal, state or local government to which this Agreement is subject, such term or provision shall be deemed severed from this Agreement and the remaining terms and provisions shall remain in full force and effect.
13. CHOICE OF LAWS, FORUM SELECTION, AND JURISDICTION:
This Agreement has been made and delivered in the State of Arizona, and it shall be construed, enforced, and governed in accordance with the laws of the State of Arizona. Billing Center and the Provider expressly agrees and acknowledge that the forum and place of any dispute and resolution of any dispute, relating to or arising out of this contract, shall be in the State of Arizona.
Each party hereto acknowledges that they have had the right and opportunity to have an independent attorney review this agreement, and that by signing, they agree, that they either had it reviewed or waive that right and by signing they hereby acknowledge that they understand each provision herein.
15. ATTORNEYS’ FEES:
In the event either party to this Agreement should bring an action or proceeding to enforce any of the terms or provisions of this Agreement, the prevailing party in such action or proceeding shall be entitled to recover its or his reasonable attorneys’ fees in such action or proceeding or upon appeal thereof.
16. MEDIATION AND ARBITRATION:
Any dispute arising hereunder, which the parties cannot resolve between themselves, using good faith, may be referred to a court-certified mediator in Maricopa County in the State of Arizona. The parties shall share equally in the cost of said mediation. In the event that said the dispute is not resolved in mediation, the parties shall submit the dispute to a neutral arbitrator certified by the American Arbitration Association in California. The decision of the arbitrator shall be final and binding. The parties shall share equally in the cost of the arbitration.
17. EXTENT OF AGREEMENT:
This agreement represents the entire agreement between the parties hereto and supersedes all prior negotiations, representations, or agreements, either written or oral. This Agreement may be amended only by BILLING CENTER, whereas PROVIDER must be furnished with written notice of any such changes.
18. AGREEMENT AND CONTACT.
By engaging Billing Center services, you are hereby agreeing to the foregoing Terms of Services. In the event of any dispute or termination of these Terms of Service, Provider may contact Billing Center via email at firstname.lastname@example.org in accordance with the termination and notice provisions herein.