Agreement made this day by and between ACG Billing Services and Greene Chiropractic clinic, hereinafter referred to as “client”. Whereas, ACG Billing Services, is in the business or providing billing and accounts receivable services for Client, and, Whereas, Client desires to contract with ACG Billing Services to perform the service set forth in items 2 and 3 below, Now, therefore, in consideration of the mutual benefits to be derived by each of the respective parties, it is agreed as follows:

1.     This agreement has no term and can be cancelled with a two-week notice. The two weeks will allow for proper turnover of passwords, work in progress and assure a smooth transition to a new billing agent/person.

2.    AGENCY. The client hereby appoints ACG Billing Services, Inc to be the client’s authorized agent for the purpose of: (1) collecting insurance benefits/payments, (2) corresponding with medical insurance companies, attorneys, and patients regarding client’s bills to patients or their medical insurers; 

3. DUTIES – BILLING PACKAGE. ACG Billing Services, Inc will, for the term specified above, perform the services which are agreen upon by each party below.

 (a) Collect payments received from insurance companies

 (b) Respond the billing inquiries made by insurance companies and attorneys.

 (c) Respond to Client’s inquiries about claims/payments

(d) Review outstanding claims weekly and rebill as needed on claims over 30 days

(e) Advise Client of unpaid claims requiring attention from client in order to get them paid.

(f) Run an A/R sheet monthly to look for high/unchanging balances that are not being paid (excludes personal injury and cash accounts)

(g) Keep track of accounts that are not paying and work with Client as needed to get accounts paid.

(h) Send week-ending reports showing patients seen, services rendered, charges, adjustments off, payments with their totals.

(i) Compare billed patient against sign-in sheet to assure every patient is billed.

(j) Additional reports as requested by Client such as quarterly sales tax and supplement sales totals, copy of A/R monthly, billed accounts on the days billing is done, and occasional other reports from Forte.

 

 

 

 

 

 

4. CLIENT’S DUTIES. Client will provide to ACG Billing Services the following:

Fee slips as requested which includes rates for services

Billing information as needed for billing functions

Bank account information and login to acquire electronic payments

 

5. PROPRIETARY & PRIVILEGED INFORMATION. ACG Billing Services, Inc covenants to treat all lists of patients and any other information including medical information obtained with respect to any patient as the proprietary and privileged information of the patient and the Client. Lists of patients will not be disclosed to any other person or entity.

 

6. COMPENSATION. Client agrees to pay ACG Billing Services, Inc for services rendered to the Client pursuant to this Agreement according to the Compensation Addendum attached hereto and incorporated herein by this reference. The addendum shall be effective on the date signed by both Client and ACG Billing Services, Inc.

 

7. INDEMNIFICATION. Client agrees to indemnify, hold ACG Billing Services, Inc harmless and defend ACG Billing Services, Inc from and against any and all claims which may be brought against ACG Billing Services, Inc stemming, resulting or arising from, the errors, mistakes, omissions, malfeasance or misfeasance of the Client with respect to their billing practices.

 

8. RECORDS. Upon termination of this Agreement, a copy of the Client’s records as well as any unused supplies will be released to Client.

9. END OF SERVICE. This contract can be terminated with two weeks notice. As compensation is based on work performed and not on actual collections, there will be no buyout.

 

10. LEGAL FEES. Should for any reason ACG Billing Services, Inc be required to attain an attorney to collect any fees due from client, all reasonable attorney’s fees, including but not limited to prejudgment interest, filing fees, costs and any consequential damages, shall be paid by client.