Chironet Billing Systems Billing Service Agreement

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Chironet Billing Systems
Billing Service Agreement
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Chironet Billing Systems
7954 Via Latina
Burbank, CA. 91504
Phone: 650-921-3376
Fax: 877-400-8291
www.chironetbs.com
Client:
Address:
State, City, Zip:
Phone:
Fax:
E-mail:
Website:
AGREEMENT:
Chironet Billing Systems (hereinafter called “Billing Center”) agrees to provide and Client agrees to
purchase services upon the terms and conditions and in accordance with the schedule and other
provisions stated herein.
SERVICES: Billing Center will electronically process and submit Client's claims to the corresponding
insurance companies and provide a computer-generated report verifying their receipt by the insurance
companies. The claims will be processed within seven (7) business days, excluding those claims that
contain errors. All claims that contain errors will be returned to the Client for corrections and billed as
corrected. Billing Center will also process all paper claims for the Client and these will be mailed once a
week to the insurance carriers.
CHARGES: The charges for Medical Claims Processing Services will be a flat percentage of Eight and one
half (8.50) percent of all collected amounts. Billing Center will charge the Client for all services billed out
including amounts applied to deductibles. Therefore we recommend the Client to collect for the
deductible at the time of service so as to maximize reimbursement and to be in compliance with all rules,
regulations and laws.
Billing Center will not charge for Co-pays or coinsurance from the EOB (Explanation of Benefits) provided
from the Insurance Company. However, if the Billing Center bills the patient for these services on behalf
of the Client then the Billing Center will charge the full contracted rate for collections as agreed upon in
section named “CHARGES”.
INVOICES: Billing Center shall invoice the client on the 1st and the 15th of every month for all services
collected during the previous period. Billing Center will provide an invoice detailing the date of collection
and the total collected for that day. The Client is required to keep accurate records of the EOB'S for each
day so they can verify the collected amounts match.
Terms are net within ten (10) days following the date of billing. Invoices unpaid within Fifteen (15) days
of the date of billing shall be subject to an interest rate of 10% per annum. If invoice remains unpaid for
a period of longer than thirty (30) days all billing will be placed on hold until the account comes current.
DELIVERY: Client agrees to fax or scan and e-mail all charges, EOB'S, statements, records and any other
items needed in order to bill, collect or be paid by Client within 48 hours of service or received by the
Client. All EOB'S and payments received by Client each day shall be faxed to the Billing Center no later
than 48 hours of receipt so Billing center can stop further collection attempts for those services.
If EOB'S or payments are not provided to the Billing Center within five (5) business days of receipt by
Client and the Billing Center attempts to collect on the service after it is paid, Client agrees to reimburse
the Billing center an additional one (1) percent above the rate agreed upon in the section named
“CHARGES”.
WARRANTY: Client warrants all services sent to the Billing Center are legally billable and performed for
the patient whose account is being billed. All service, chart notes, Insurance claims and any other items
are all deemed legal by the Client when sent to the Billing Service. Billing Service agrees to bill all
charges, services, procedures, etc in accordance with all laws, rules and regulations of all governing
agencies and agrees to not perform any illegal billing activities.
TERMINATION: This agreement may be cancelled by the client by giving the Billing Center thirty (30)
day's prior written notice. This agreement may be cancelled by the Billing Center by giving the Client
ninety (90) day prior written notice. Upon termination of service, Client agrees to remit immediately to
Billing Center all charges and fees to date. All services billed and collected within the following forty-five
(45) days will be paid in full to the Billing Center in the same manner as agreed upon in sections titled
“CHARGES” and “INVOICES”. All closing patient records and documents must be accepted by the client.
GENERAL: The term “this agreement” as used herein includes any future written amendments,
modifications, supplements, or schedules duly executed by Billing Center and the Client. This agreement
will be governed by the laws of the State of California. At Billing Center's option any dispute under this
agreement shall either be submitted to binding arbitration in the city of Belmont, under the rules then
prevailing of the American Arbitration Association, or filed in California State Court, to which Client
submits to jurisdiction. Billing Center is entitled to reasonable Attorney's fees for the enforcement of this
agreement at any stage of enforcement proceedings, including appeal. The waiver by either party of any
default or breach of the same or of a different kind. This agreement constitutes the whole contract
between the parties and may be changed only by a memorandum signed by both parties. Should any
provision of this agreement be unenforceable or against public policy, the parties agree that the
remaining portions of the agreement will be binding upon the parties.
Billing Center Acceptance By:
Accepted and Approved by Client:
Signature:
Signature:
Title:
Date:
Title:
Date: