Medical Billing Contract Template

Important Notice

The following document provides a general framework for establishing billing agreements within the healthcare industry. It is intended solely for informational purposes and does not substitute for legal or professional advice. Parties should consult with qualified legal or industry experts to ensure compliance with applicable laws, regulations, and best practices relevant to their specific jurisdiction. Use of this template is at the user’s own risk, and no liability is assumed for errors, omissions, or decisions made based on this material without proper professional consultation.

Please note: This is a sample Medical Billing Contract Template, intended for illustrative purposes only. Actual contractual language should be tailored to specific circumstances and legal advice obtained accordingly.

Medical Billing Contract Sample

Parties Involved:

Healthcare Provider: ABC Medical Clinic
Address: 789 Health Ave, Cityville, ST 12345

Billing Service: XYZ Medical Billing Services
Address: 456 Billing Road, Cityville, ST 12345

Scope of Services:

The Billing Service agrees to manage and process medical claims on behalf of the Healthcare Provider, including submitting claims to insurance companies, following up on unpaid claims, and providing reporting related to billing activities.

Terms and Compensation:

This agreement commences on __________________ and continues until terminated by either party with thirty (30) days’ written notice. The Healthcare Provider agrees to pay the Billing Service a fee of _____% of collected reimbursements or a flat fee of $____ per claim submitted, payable monthly.

Confidentiality and Responsibilities:

Both parties agree to maintain the confidentiality of protected health information (PHI) in accordance with applicable laws. The Billing Service shall perform its duties professionally and accurately, and the Healthcare Provider shall provide necessary documentation and access to relevant records in a timely manner.

Governing Law:

This agreement shall be governed by the laws of the state where the Healthcare Provider is located. Any disputes shall be resolved within the jurisdiction of that state’s courts.

Additional Provisions:

• The Billing Service shall not use or disclose PHI except as permitted or required by this agreement or required by law.
• Modifications to this contract must be made in writing and signed by both parties.
• Either party may terminate this agreement with thirty (30) days’ written notice.

Cityville, ______________________