CLIENT SERVICES AGREEMENT
This Billing and Collection Services Agreement (the "Agreement") is made and
entered into by and between East Texas Billing & Claims, ("ETBCÓ"), a Texas
company, and, (the ÒClientÓ), to be effective; WHEREFORE, ETBC is a Texas
company providing medical billing and collection services to medical service
providers and health care institutions.
WHEREFORE, Client operates a _________________________________;
WHEREFORE, Client desires to engage ETBC to supply billing, collection and
related services in connection with the Client's business operation, and ETBC
desires to be so engaged, and possesses the equipment, personnel and other
resources necessary to provide the services described in this Agreement.
NOW,THEREFORE: For and inconsideration of the mutual covenants and agreements
contained herein, the parties, each intending to be legally bound hereby, agree
and contract as follows:
- 1.0 SCOPE OF ENGAGEMENT. ETBC shall, on behalf of Client, provide the
necessary hardware, software and personnel to key related charges, file
insurance claims and to bill patient/guarantors appropriately, and also to
post payments and provide necessary management reporting.
- 2.0 APPOINTMENT OF AGENT. Client appoints ETBC, for the term of this
- Agreement, to he its true and lawful agent and attorney-in-fact to bill
patients in Client's name and on its behalf; to collect accounts receivable
resulting from such billing in Client's name and on its behalf; and with
Client's prior written consent, to initiate legal proceedings in the name of
Client to collect any accounts and moneys owed to Client, to enforce the
rights of Client as creditor under any contract or in connection with the
rendering of any service, and to contest adjustments and denials by
governmental agencies (or fiscal intermediaries) as third-party payers. The
performance of all billing and collection functions by ETBC shall comply with
state and federal statutes, regulations and directives applicable to such
functions.
- 3.0 REPORTING AND RELATED SERVICES.In the performance of its billing and
collection services herein ETBC shall:
(1) provide tracking, patient billing, follow-up, insurance/invoice
processing, posting and related services for Client;
(2) prepares and send to Client by the tenth day of each month, ETBC's
standard monthly collection report for the previous month;
(3) establish a mutually agreed procedure, including documentation for
handling unpaid accounts and for the request, use, maintenance and return ofÊ
patient files; and
(4) use only charges, diagnoses and common procedural terminology codes
provided by Client, and not alter or create patient records but work only from
those provided by Client. ETBC shall also prepare and submit to Client on a
monthly basis the customary reports of ETBC derived from the services
performed by ETBC pursuant to this Agreement.
- 4.0 RESPONSIBILITIES OF CLIENT.
- 4.2 Data Entry. Client agrees to enter all required patient information,
including demographics, charges and codes into the system designated by ETBC
and in accordance with ETBC's written policies and procedures.
- 4.3 Employee Compliance. Client agrees its employees shall participate in
any training or educational programs reasonably required by OS1 and to comply
with the responsibilities of Client pursuant to this Agreement.
- 4.4 Accuracy of Information; Reliance by ETBC. All information provided by
Client to ETBC in the performance of its services hereunder shall be true,
complete and accurate in all respects. ETBC shall be entitles to rely on all
such information (including, but not limited to, billing, charging and coding
information and provider numbers) without conducting any independent
investigation.
- 4.5 alancing. Client agrees to comply with all ETBC balancing policies and
procedures.
- 5.0 RELATIONSHIP OF THE PARTIES. ETBC is entitled to act as the limited
agent of Client only to the extent provided by and in accordance with this
Agreement. Neither party is, or is intended to be. a partner, joint venturer
or employee of the other party, and neither party shall have the authority to
bind the other party except as expressly contemplated by this Agreement.
- 6.0 HANDLING OF FUNDS/ETBC COMPENSATION. ETBC compensation shall be as per
Exhibit ÔAÓ that is attached and made a part of this agreement. All receipts
for professional medical services rendered by Client will be remitted to the
Client. The Client shall forward a copy of the explanation of benefits
associated with such receipts to ETBC, whereby ETBC will subsequently provide
cash application services to assure proper posting of payments.
- 7.0 MAINTENANCE OF RECORDS. ETBC agrees to maintain copies of all records
produced pursuant to this Agreement for a period of not less than four (4)
years from the date of creation, or longer as may be required by applicable
law, and not to dispose of any records created pursuant to this Agreement
without the prior authorization of Client. If ETBC is requested to disclose
any books, documents or records relevant to this Agreement for any purpose,
ETBC shall notify Client of the nature and scope of such request in advance of
disclosure, so as to provide Client with a prior opportunity to contest
disclosure.
- 8.0 TERM OR TERMINATION
- 8.1 Term. This agreement shall be effective as of the Effective Date, and
continue for a term as stated on Exhibit ÒAÓ (the ÒPrimary TermÓ) unless
earlier terminated pursuant to the provisions of this Agreement.
- 8.2 Termination Without Cause. Notwithstanding any other provision of this
Agreement either party may terminate this agreement at any time by giving at
least 12 months prior written notice to the other party.
- 8.3 Termination With Cause. If either party defaults in the performance of
any term or condition of this agreement and the default is one which may be
cured, the party in default must cure that default by a satisfactory
performance within ninety (90) days of written notice of default. If the party
in default fails to cure the default within the ninety (90) day period, the
party not in default may terminate this Agreement forthwith by providing
written notice to the breaching party.
- 8.4 Termination for Insolvency. This Agreement shall terminate
automatically and immediately upon a loss of solvency of either party.
- 8.5 Effect of Termination. ETBC shall continue to provide billing services
to Client up to the effective date of termination. Reimbursement to ETBC for
services rendered before and/or during any such extension period shall be paid
by Client in the same manner as during the term of this Agreement. Termination
of this Agreement shall have no effect upon the rights and obligations of the
parties arising out of any transactions or services provided or occurring
prior to the effective date of such termination.
- 8.6 Responsibilities. It shall be the responsibility of ETBC to furnish
all data and information that it has stored for Client. This includes all
disks, UB-92's and any and all pertinent information that Client deems
necessary. This information shall be supplied to Client no later than fifteen
(15) days following the effective date of termination.
- 9.0 TERMINATION/COMPENSATION In the event of termination of this agreement
for any reason, ETBC shall be entitled to any and all compensation accrued and
unpaid up to the date of termination. Any and all accrued fees shall be paid
in full by Client prior to the release of any information stored at ETBC
office.
- 10.0 TRADE SECRETS. The parties acknowledge in the conduct of their
respective obligations under this Agreement each will have access to the
confidential, proprietary and trade secret information of the other. Client
and ETBC each agree not to disclose any confidential, proprietary or trade
secret information of the other which may he ascertained as the result of the
performance of this Agreement, the use or disclosure of which might reasonably
be construed to be contrary to the best interests of the other party. Upon
termination of this Agreement, neither party will take or retain any papers,
records, files, computer programs and software, other documents or copies
thereof, or other confidential information of any kind belonging to the other
party. Without limiting other possible remedies available for breach of this
covenant. Client and ETBC each agree injunctive or other equitable relief
shall be available to enforce this covenant, such relief to be available
without the necessity of posting bond.
- 10.1 During the term of this Agreement and for one (1) year after
termination, CLIENT will not, directly of indirectly (e.g. CLIENT hires or
uses another company that hires ETBC's employees), employ or contract with any
ETBC employee or agent (or any enterprise in which any ETBC employee or agent
owns a greater that 5% interest) who has provided services to the CLIENT on
behalf of ETBC within the previous year, for the purposes of providing
management, consulting, or rehabilitation services, without the express
written consent of ETBC. CLIENT and ETBC agree that CLIENT's breach of this
provision will cause irreparable damage to ETBC and that, in addition to other
remedies available at law, an injunction or other equitable remedy shall issue
to enforce this provision. CLIENT and ETBC further agree that it will be
difficult to fix the exact amount of damages suffered by ETBC in the event of
a breach by CLIENT of this provision and, accordingly, agree to liquidated
damages to ETBC in the amount of $20,000.00.
- 11.0 DISCLAIMER OF LIABILITY. Client shall have the sole responsibility
for all source information provided ETBC and ETBC shall have no obligation to
verify, check or otherwise inspect the source information furnished by Client,
Client agrees to identify and hold ETBC harmless against any and all
liability, loss, damages, costs and expenses which ETBC may incur including,
but not limited to, attorney's fees and cost, which ETBC may be required to
pay, directly or indirectly, results in any liability, loss and/or damage to
ETBC. Neither ETBC nor Client shall be liable to any third person for any
damages which said third person may incur, directly or indirectly, as a result
of the errors or omissions of the other. Client and ETBC each covenant,
warrant, represent and agree neither it nor any person or firm connected with
it has participated or will participate in any act or action that is or may be
found to be in violation of any state or federal law, regulation, decree,
policy or directive including, but not limited to, those laws and regulations
pertaining to the submission of claims for payment to public and private third
party payers for health care goods and services. If a violation of this
provision is discovered or occurs, a material breach of this Agreement shall
result, and the non-defaulting party shall have the option, in its sole
discretion, to terminate this Agreement immediately upon notice to the
defaulting party.
- 11.1 Hold Harmless. It is the intent of the parties to this contract,
regardless of any language to the contrary, to indemnify the other party to
the extent legally possible, against all claims by third parties, arising from
actions of the affected party in performance of this contract.
- 12 NO PRACTICE OF MEDICINE. Nothing in this Agreement is intended to
constitute the use of a medical license for the practice of medicine by anyone
other than a licensed physician; aid ETBC or any other corporation to practice
medicine when in fact such corporation is not licensed to practice medicine;
or result in any other act or create any other arrangement in violation of the
laws of Texas or the United States of America.
- 13 NO REFERRALS. This Agreement is not intended to induce or encourage the
referral of any patients. The parties agree the benefits to each other
hereunder do not require, are not compensation, payment or inducement for, and
are not in any way contingent upon, the admission, referral or any other
arrangement for the provision of any item or service offered by any person to
any patient(s).
- 14 MISCELLANEOUS.
- 14.1 Assignment. Neither party shall, without the prior written consent of
the other, assign any rights or delegate any duties under this Agreement.
- 14.2 Amendment. This Agreement may be amended only by an instrument in
writing signed by the parties hereto.
- 14.3 Notice. Whenever, under the terms of this Agreement, written notice
is required or permitted to be given, such notice shall be deemed to have been
delivered upon receipt if delivered personally or by confirmed facsimile, or
on the third business day after such notice is deposited in the United States
mail in a properly stamped envelope, certified mail, return receipt requested,
addressed to the party to whom it is to be given at the address set forth
below:
To ETBC:
East Texas Billing & Claims
P.O. Box 365
Carthage, TexasÊ 75633
To Client:
____________________________________
____________________________________
____________________________________
____________________________________
- 14.4 Entire Agreement. This Agreement, including Exhibits ÒAÓ and ÒBÓ
attached hereto, sets forth the entire understanding and agreement between the
parties and shall be binding upon the parties, their affiliates, successors
and permitted assigns. Any and all prior negotiations, agreements and
understandings are superseded hereby.
- 14.5 Section Headings. The headings preceding the text of the several
sections of this Agreement are inserted solely for convenience of reference
and shall not constitute a part of this Agreement nor affect the meaning or
construction of any section hereof.
- 14.6 Governing Law and Venue. This Agreement shall be governed by and
construed in accordance with the laws of, or applicable to, Texas, and in the
event of any litigation at any time arising hereunder the venue of such
litigation shall be exclusively in Panola County, Texs. In the event of any
litigation arising hereunder, the prevailing party shall be entitled to
recover reasonable attorney's fees as awarded by the court, together with all
costs of any such action.
- 14.7 Severability. Should any part of this Agreement for any reason be
declared invalid, the validity of any remaining portions hereof shall not be
affected thereby, which remaining portions shall continue in force and effect
as if this Agreement had been signed with such invalid portion eliminated. The
intention of the parties is the remaining portions of this Agreement would
have been signed without including any such part, parts or portion which may
for any reason hereafter be declared invalid.
- 14.8 Counterparts. This Agreement may be signed in any number of
counterparts with the same effect as if the signature on each such counterpart
were on the same instrument.
EAST TEXAS BILLING & CLAIMS
By:____________________________________
Its: __________________________________
Date:__________________________________
_______________________________________
By:____________________________________
Its:___________________________________
Date:__________________________________
EXHIBIT A
ETBC SERVICES:
- To provide the appropriate billing (Insurance, Invoice and/or Statements),
and comprehensive follow-up on the status pending claims, invoices or
accounts.
- To provide appropriate means of collections to resolve accounts.
- To provide patient/employer and insurance inquiry services via mail or
telecommunications.
- To provide cash application services to assure proper posting of payments.
- To provide customized and periodic reporting for the purpose of financial
and statistical data.
- To provide additional training as needed to new and existing employees.
- To provide 24 hour a day access to the software system and support.
ETBC COMPENSATION:
- ¥ETBC will be compensated twice monthly at a rate of______%25 for services
rendered.
TERM OF AGREEMENT
The term of this Agreement is 12 months, commencing the latest date noted on the
Signature blocks of this document. This will automatically renew unless
terminated as stated in Article 8.0.
EXHIBIT B