MEDICAL BILLING SERVICES AGREEMENT
This Billing Services Agreement (the “Agreement”) is effective as of March 1st, 2021 by and between ALLIANCE CODING & CONSULTING INC. (“ACC”) and End User (“CLIENT”), a licensed healthcare provider located in the United States.
In consideration of the representations, covenants and agreements contained in this Agreement and the attached Addenda, CLIENT and ACC agrees as follows:
1. Services. ACC will apply its best efforts to obtain reimbursement for CLIENT’s charges for all virtual visits (“Medical Services”) coordinated by the FaceMyDoc telemedicine platform rendered on or after the Effective Date, through billing of patients and third party payers and the management of CLIENT’s accounts receivable (the “Services”). During the term of this Agreement, ACC will be the exclusive provider of the Services to CLIENT. Addenda 1 and 2, incorporated by reference, describe additional services, which will be considered to be Services as defined above. Unless Agreement is expressly altered in accordance with Section 18, below, no additional services are included nor are any services omitted unless expressly waived by Client.
2. Term. The initial term of this Agreement will be for twelve (12) months (the “Initial Term”) from the Effective Date. This Agreement will automatically renewed for successive additional 1 year terms, unless either party gives the other written notice at least ninety (90) days before the end of the then current term. Notwithstanding the foregoing, this Agreement can be terminated at any time on written notice for cause consisting of a material breach of a term or condition hereof which is not corrected within thirty (30) days of prior written notice describing the breach in reasonable detail. This Agreement may also be terminated on written notice in the event either party becomes excluded from participation by the Medicare or Medicaid program; ACC becomes legally unable to provide the services contemplated herein; or CLIENT becomes legally unable to provide medical services, insolvent or files for bankruptcy protection, or as otherwise specified herein.
3. Fees. Beginning as of the Effective Date, CLIENT agrees to pay ACC, a base fee of 12% per month of net collections (the “Base Fee).
Net collections shall be defined as the total sum of all monies collected by ACC for all medical services rendered by CLIENT, less amounts refunded or credited to patient or third party payer as a result of overpayments, erroneous payments or bad checks. The Base Fee shall also be charged for net collections received through collection agency recoveries.
Notwithstanding the foregoing, in the event that: CLIENT fails to disclose to ACC, at or prior to the time this Agreement is executed, information relating to CLIENT’s practice, which information, if disclosed, would have materially increased the costs of billing and collection efforts incurred by ACC; or CLIENT materially changes fundamental aspects of its practice (such as its practice sites, the type of services provided, its payer mix, quality or type of demographic information available, method of documenting services provided or the like), ACC may propose an adjustment to the Base Fee in writing (the “Adjustment Proposal”). For the thirty (30) day period after CLIENT’s receipt of the Adjustment Proposal (the “Discussion Period”), ACC shall be available to discuss the basis for the amount of the proposed adjustment with CLIENT. If CLIENT agrees to the proposed adjustment, this Agreement will be amended to reflect the new Base Fee. If, on or before the end of the Discussion Period, CLIENT has not accepted the proposed adjustment or the parties have not otherwise agreed as to an adjustment to the Base Fee, ACC may terminate this Agreement on ninety
(90) days advance written notice. Changes in the Base Fee under clause (a) shall be retroactively effective to the Effective Date; changes under clause (b) shall be effective as of the end of the Discussion Period.
In addition to the Base Fee, CLIENT will reimburse ACC for:
A. Postage charges for direct patient statements (initial bills and rebills or reminders) sent out on CLIENT’s behalf, charged to CLIENT at cost;
B. A reasonable per-hour claims processing charge where CLIENT, after written notice from ACC, continues to submit incomplete or incorrect data for billing (collectively, “Additional Charges”).
C. If requested by CLENT, Provider enrollment services at the rate of $ 89 per application for each new completed application and $ 49 per application for each application renewal or update completed.
D. To the extent ACC stores CLIENT documents relating to the Services unrelated to active accounts, CLIENT shall be responsible for payment of storage costs for all CLIENT documents required to be maintained by ACC greater than one hundred twenty (120) days. The documents shall be stored at an offsite location in the CLIENT’s name and such charges shall be billed directly to the CLIENT. Selection of a storage facility shall be at the option of CLIENT, provided that the facility will be conveniently located for access by ACC. ACC shall have full access to the storage facility and shall remain responsible for the management of stored records during the term of this agreement and any extensions thereof. Alternatively, if ACC determines it to be appropriate, ACC may optically scan such records, in which case CLIENT will be responsible for ACC’s costs of scanning at the rate of $0.10 (ten cents) per page. If ACC elects to optically scan records, it will provide CLIENT with written notice. If CLIENT advises ACC in
writing within thirty (30) days of receipt of such notice, ACC will tender the paper records that are scanned to CLIENT; if CLIENT does not respond within that period, ACC may destroy the paper records.
E. ACC shall have no responsibilities relating to billing of CLIENT’s claims with dates of service prior to the Effective Date, absent a specific separate written agreement. In the event that CLIENT wishes to contract for such additional services, ACC will provide a separate proposal and fee quotation that will apply to those services.
F. CLIENT agrees to pay the Base Fee and Additional Charges within ten (10) days after receipt of each invoice from ACC. ACC shall maintain supporting documentation of the basis for the allocation of postage costs, and shall provide such data upon request. Fees not timely paid will bear interest at the rate of eighteen percent (18%) per year or the maximum rate allowed by law, if less.
G. Notwithstanding anything to the contrary in this Agreement, ACC will have the right to terminate this Agreement immediately if CLIENT defaults on its payment obligations of any undisputed amounts due under Section 3 and such payment default is not cured within ten (10) days after ACC delivers written notice of such default to CLIENT. In addition, in such event, ACC may, in its sole discretion, decline to provide the wind-down services specified in Section 8 a, b and c and cease Services as provided in Section 8 d. until and unless Base Fees and Additional Charges are paid with interest.
4. Bank Account. A bank account will be maintained in the name of CLIENT at a bank approved by CLIENT and acceptable to ACC (“CLIENT ACCOUNT”) and all cash receipts will be deposited daily into the bank account by ACC, or into a lockbox account, at the election of the CLIENT. ACC will have no signatory or ownership rights in the bank account and will have no right to negotiate checks or assert ownership rights in deposited funds. To the extent the parties agree CLIENT shall instruct its bank to sweep funds from the Client Account into an account to which ACC has signatory power for the purpose of provision of the Services (“Sweep Account”). CLIENT may revoke instructions to its banking institution to sweep funds into the Sweep Account at any time, but ACC may terminate this Agreement immediately upon such revocation. To the extent required by ACC, CLIENT shall insure that the banking institution provides depositary or other information directly to ACC or copies of documents relevant to establishment or verification of net collections CLIENT shall be solely responsible for all bank charges.
5. Operating Procedures. CLIENT agrees to provide or to cause facilities or other sites at which CLIENT provides Medical Services to provide to ACC with accurate and complete demographic, procedure and charge information, at no cost to ACC (“Demographic Information”). CLIENT acknowledges that ACC will rely on the Demographic Information in providing the Services and
that the timing and amount of Net Collections generated by the Services are affected by the completeness, timeliness and accuracy of the Demographic Information and other variables, some of which are beyond the control of ACC. To the extent possible, at the request of ACC, CLIENT will ensure that the foregoing information is provided to ACC in electronic form, in a standard form and format reasonably consistent with ACC’s computer system.
A. ACC will bill and attempt to collect CLIENT charges in a manner consistent with all applicable Federal, State and Local laws and regulations and within the policies and procedures of third party payers that are made known by such payers to medical practices and billing companies or otherwise known by ACC. ACC does not provide collection agency services but may recommend to CLIENT an appropriate collection agency for collection accounts if such services are to be engaged.
B. The parties may, from time to time, mutually agree to specific operating policies and procedures related to the performance of Services under this Agreement. Any such operating policies and procedures, or amendments thereto, will, upon mutual written and signed agreement, become an integral part of this Agreement and shall be binding upon both parties. The foregoing shall not prevent ACC, at its sole discretion and at its own cost, from establishing and maintaining its business operations and procedures relating to the Services in a manner consistent with this Agreement.
6. Confidential Information. ACC agrees not to disclose to anyone other than CLIENT any information about CLIENT’s fee structure, internal compensation, managed care or facility contracting strategies, or similar business information that would commonly be understood to be confidential or any confidential medical information regarding CLIENT’s patients received in the course of performing the Services (collectively, CLIENT’s “Confidential Information”), except as required to bill charges, as required by law or legal or regulatory process or as otherwise provided herein .
CLIENT agrees that is will not disclose to third parties the business methods, operating processes or documentation of the software employed by ACC to provide the Services or any information about ACC’s fees, operations, business methods or strategies or any other information specifically designated as confidential by ACC except as required by law or legal or regulatory process (ACC’s “Confidential Information”). Each party’s Confidential Information shall remain the property of that party, during and after this Agreement.
Each party will at all times take reasonable steps to establish and enforce the foregoing by its employees, independent contractors, consultants and vendors. The requirements of this Section 6 shall expressly survive the expiration or termination of this agreement. Each party specifically agrees to comply with, and assist their counterpart with compliance with applicable state or federal confidentiality requirements as to individual patient information. Notwithstanding the preceding sentences, CLIENT agrees that ACC may use CLIENT information for research and statistical compilation purposes, so long as CLIENT and patient identifying information is kept confidential in accordance with applicable law and that any product of the foregoing uses shall be the property of ACC.
In addition to the rights and obligations of ACC set forth in this Section 6, the rights and obligations set forth in the Business Associate Agreement attached to this Agreement as Addendum 3 and incorporated by reference shall apply to protected health information as defined in said Exhibit.
7. Software and Proprietary Information. ACC affirms that it will at all times during the term of this Agreement, have a valid and current copy of and license for use of any third party software used to provide the Services and that the CLIENT will be given timely notice of any changes in third party software vendor or system to the extent those changes would materially affect the Services. The parties agree that ACC may store Demographic Information, back-up documentation, statements, explanations of benefits, payer inquiries and other information it
receives in connection with the Services (“CLIENT Information”) in electronic form through optical scanning or other technologies selected by ACC and that ACC is not obligated to maintain paper copies. ACC further affirms that it will at all times maintain a current and complete copy of all CLIENT Information in a secure, off-site location and that no CLIENT data shall be deleted or purged unless: (a) a period of seven years has passed since the date of service relevant to the CLIENT Date; or (b) CLIENT has given approval of such data deletion.
It is specifically acknowledged that all CLIENT Data is the property of CLIENT but that ACC may maintain a copy for documentation of Services and for other purposes relating to this Agreement during and after the term of this Agreement, subject to the terms and conditions of Section 6., above.
8. Termination Procedures. In the event this Agreement is terminated, for whatever reason, or expires, except as specifically stated in Section 3. G, ACC will:
A. continue to perform Services, at the then-current rates hereunder, for a period of thirty (30) days after the effective date of termination (the “Wind Down Period”) for all of CLIENT’s accounts receivable relating to CLIENT’s charges for Medical Services rendered prior to the termination date (“Existing Accounts Receivable”);
B. CLIENT expressly agrees to cooperate and assist ACC with its performance during the Wind Down Period and will timely report, or cause to be reported, all payments applicable to the Existing Account Receivable for which ACC is responsible.
C. at the end of the Wind Down Period, discontinue performing Services as to CLIENT’s Existing Accounts Receivable;
D. deliver to CLIENT, after and conditioned upon full payment to ACC of all undisputed fees owed to ACC by CLIENT under this Agreement, a complete list of Existing Accounts Receivable (all debit and credit balances) in an industry standard electronic format, including data layout and/or translation tables;
E. except for the foregoing or for such other matters as the parties may agree to in writing, after the effective date of termination, ACC shall have no further obligations to provide Services to CLIENT under this Agreement. CLIENT may negotiate with ACC for additional transitional services or for the provision of additional data, including CLIENT Data, to be provided by ACC after the date of termination at CLIENT’s additional expense.
9. Non-Employment. During the term of this Agreement and for a one (1) year period commencing with the termination of this Agreement, each party agrees not to employ, directly or indirectly, any individual who was an employee of the other party during the term of this Agreement without written consent of the other party. Each party agrees that the other party does not have an adequate remedy at law to protect its rights under this section and agrees that the non- defaulting party will have the right to injunctive relief from any violation or threatened violation of this Section. In lieu of injunctive relief, the non-defaulting party may elect to require reimbursement by the defaulting party a $10,000 recruiting and retraining fee per employee hired in violation of this Section 9.
10. Notice. Any notices, payment, demand or communication required or permitted to be given by the provisions of this Agreement will be effective on the date of receipt if sent or delivered to ACC, Attention: President, if to ACC; and CLIENT, Attention: President and Treasurer if to CLIENT.
11. Governing Law and Jurisdiction. This Agreement shall be interpreted and governed by the laws and statutes of the State of New York. In the event of disputes, it is agreed that all matters shall be tried in the state or federal court having jurisdiction of Suffolk County, New York. Each party consents to jurisdiction and venue of said courts.
12. Disputes. Any dispute arising under this agreement may be resolved by the parties in a judicial forum or, if the parties agree, by arbitration, according to mutually agreed rules.
13. Independent Contractors. The parties to this agreement are each independent contractors and nothing in this agreement shall be construed to create a partnership, joint venture or other relationship between either party.
14. Insurance. ACC affirms that at all times during the term(s) of this Agreement, it shall have in force valid Worker’s Compensation insurance covering all of its employees, as well as General Liability Insurance, Fidelity Bond insurance, and Errors and Omissions insurance. ACC shall give CLIENT timely notice of the cancellation or lapse of any of the above policies and ACC agrees that such lapse or cancellation shall be deemed cause for termination of this Agreement.
15. Inspection. CLIENT, its agents and representatives, shall at all times during the term of this Agreement, have reasonable access, during regular business hours, to review and inspect the location(s) where the services are performed upon seven (7) days advance written notice to ACC by CLIENT. Any inspection performed shall be governed by the confidentiality provisions of this Agreement and shall be conducted so as not to disrupt ACC’s staff or business. ACC shall not unreasonably deny, restrict or delay access for any requested inspection.
In the event that CLIENT engages the services of an outside party to conduct or assist in any inspection, CLIENT shall ensure that all other parties are bound by a Confidentiality Agreement identical or substantially similar to the one applicable to the parties to this agreement.
16. Force Majeur. It is mutually agreed that in the performance of all duties by each party under this Agreement, time is of the essence. However, performance of duties hereunder may be impeded by occurrences beyond the control of one or both parties. Events such as flood, earthquake, hurricane, tornado, blizzard and other natural disasters; fire, riot, war or civil disturbance; strikes by common carriers; extended loss (more than 48 hours) of utilities (except for non-payment); and similar events shall excuse the affected party from performance of services impeded by such event(s). Nevertheless, each party has a duty to use reasonable efforts to prevent or mitigate such impediments. In the event that any catastrophe shall prevent the timely billing of CLIENT’s services by ACC for more than fifteen (15) working days, CLIENT shall have the right to secure, without penalty, substitute services until ACC can restore services, at which time ACC’s responsibilities and rights under this Agreement shall be reinstated. For its protection, CLIENT shall, at its own expense, purchase and maintain business interruption and/or accounts receivable insurance to cover any such catastrophic event, as stated above.
17. Incorporated Documents. It is specifically agreed that Addenda 1, 2, and 3 are incorporated herein as in integral part of this Agreement.
A. This Agreement contains the entire agreement of the parties relative to the services to be provided to CLIENT and no representations, inducements, promises or agreements, oral or otherwise, between the parties not embodied in the Agreement will be of any force or effect.
B. This Agreement specifically supersedes any prior written or oral agreements between the parties relating to the provisions of the Services.
C. This Agreement is binding upon, and inures to the benefit of and is enforceable by ACC, CLIENT and their respective legal representatives, assigns and successors in interest, subject to Section 19 (d) below.
D. Neither party may assign this Agreement without the prior written consent of their counterpart, provided that this Agreement will be deemed assigned to, and will be binding upon, the survivor in any merger or business combination involving a party or the purchaser of all or substantially all of the assets of a party.
E. Any amendments or changes to this Agreement will be in writing and will not be effective until executed signed by both parties.
F. ACC and CLIENT acknowledges that they are duly authorized by appropriate corporate action to enter into this Agreement and that this Agreement is being signed by duly authorized agents authorized to act on their respective behalf.
G. This Agreement may be executed in the singular or in identical counterparts. Once signed by all parties, each counterpart document shall have equal binding effect.
IN WITNESS WHEREOF, the parties hereto have duly executed and delivered this Agreement as of the Effective Date by checking the box labeled “Medical Billing Services Agreement” on the Provider Signup form and clicking submit.
ADDENDUM 1: RESPONSIBILITIES OF EACH PARTY
In performance of their duties for the collection of reimbursement for services rendered by CLIENT, ACC shall:
1. Perform coding from information provided by or on behalf of CLIENT, including service reports, as required by third party payers, inclusive of, but not limited to: CPT, including applicable modifiers, and ICD-10 CM coding schemes. All coding services shall conform to currently applicable and published rules and guidelines issued by the American Medical Association, the Centers for Medicare and Medicaid Services, and/or the World Health Organization and other copyright owners of coding formats.
Without waiver of its other rights and remedies, ACC is expressly relieved of any obligation of performing coding services if:
a) Complete and legible documentation to support the assignment of codes has not been supplied; or,
b) The code(s) to be assigned are not adequately supported by the documentation supplied; or,
c) Clear and unambiguous coding rules and/or guidelines are not available or are in dispute; or,
d) The identity of the provider of services for whom coding shall be performed is missing or uncertain.
2. Use reasonable efforts to enter all procedural and demographic data necessary for patient and third party billing into its billing system in a timely (within five business days of receipt) in an accurate manner subject to CLIENT’s obligation under the Agreement to provide accurate and complete demographic information.
3. Submit claims electronically to all third party payers regularly billed by ACC that are capable of accepting claims in electronic format, subject to a minimum monthly claim volume of TBD claims per payer and further subject to the reasonable cooperation of each payer.
4. Issue bills to individuals for all self pay balances owed, with monthly statements. CLIENT will be given limited discretion regarding the wording to appear on bills and letters and shall warrant that all proposed language conforms to applicable state and federal collection laws. After completion of the foregoing cycle, the account will be referred to a third-party collection agency selected by CLIENT that may be recommended by ACC. ACC is not responsible for the actions or results of such collection agency.
5. Issue initial billings to patients and/or third parties within 5 business days of receiving all required information.
6. Provide toll free phone lines for patient inquiries and adequate phone inquiry staff to effectively respond to patients in a reasonable amount of time.
7. Prepare and deliver month-end reports of the billing performance and practice statistics in a format essentially similar to Exhibit A no later than the tenth (10th) business day of the next month. This duty may be fulfilled by electronic and/or paper reports.
8. Have its staff present reports of billing performance via email to CLIENT on a monthly basis for the first 3 months of the initial term and, thereafter, at least quarterly, at a time convenient to both ACC and CLIENT and at CLIENT’S option.
9. Produce monthly credit balance reports and advise the CLIENT of refunds due to both patients and third parties.
10. Prepare refund checks as directed by CLIENT for CLIENT signature, unless prohibited by third party payer rules or regulations. CLIENT is solely responsible for funding and promptly issuing such refunds. Failure by either party to fulfill their respective duties shall constitute a material breach of the Agreement.
11. Provide CLIENT with regular (at least quarterly) reports of all CPT and ICD-10 CM statistics, showing the pattern of codes processed, by individual code.
12. Provide CLIENT with regular (at least quarterly) reports of all claim denials, rejections, payment reductions or other official notices received from third party payers.
13. Maintain and follow a written program for quality assurance in the areas of coding and billing regulatory compliance.
14. Use reasonable efforts to advise CLIENT with respect to any material change in third party rules and regulations which are made known to providers and third party billing agents or otherwise known to ACC.
15. Apply for and monitor progress of physician and CLIENT applications for third Party Identification numbers at the rates outlined in the Fees section of the Agreement. CLIENT acknowledges that ACC will promptly submit such application following receipt of all required information but is not responsible for the timeliness of payer completion of the enrollment process and that payer completion may affect reimbursement for CLIENT charges.
16. Review and make timely recommendations with respect to coding, service descriptions and professional fees for the CLIENT fee schedule prior to the onset of billing activity and at least annually, in December, thereafter.
CLIENT, in supporting the success of the billing process and to facilitate optimal performance by ACC, shall:
1. If not available to address matters related to Services under this Agreement, CLIENT shall identify one administrative and one clinical representative to whom ACC may, respectively, address all said matters. If ACC performs coding for CLIENT, CLIENT may also appoint a coding representative. All CLIENT representatives will have the power to agree, on behalf of CLIENT, to mutually agreed resolutions to any issues arising in their respective areas, and to, upon ACC’s request, receive confirmatory memoranda or letters, which will thereupon be incorporated into this Agreement by reference. These individuals will provide timely response to all reasonable requests by ACC.
2. CLIENT warrants that ACC may rely on the existence of: patient signatures on assignment of benefits, medical information releases and Advance Beneficiary Notices and, physician signatures on charts and other medical documents, as required for submission of claims on behalf of CLIENT and upon the accuracy and completeness of all information furnished to ACC by CLIENT or on CLIENT’s behalf as to the services rendered by CLIENT.
3. CLIENT (and their providers, if applicable) will identify the diagnosis or medical condition that supports the medical necessity of a patient’s services, if one exists. ACC shall not be responsible for claim denials, partial payments or payment reductions resulting from services that are deemed ‘not medically necessary’ by third party payers, beyond their duty to assure that such non-payment decisions are not arbitrary or otherwise inappropriate and are not based on data entry or other clerical or computer system errors.
4. CLIENT will assist ACC in working with and/or resolving problems related to work performed by personnel employed by hospitals, labs and other institutions in order to achieve the goals of this Agreement and the provision of Services by ACC in an efficient and cost-effective manner.
5. CLIENT will provide a response within three (3) business days to chart and other information requests, made by payers and forwarded from ACC. CLIENT acknowledges that failure to comply with this duty may result in claim denial, payment reduction or forfeiture of payment or appeal rights.
6. Upon receipt of the requisite research and worksheets from ACC, CLIENT will timely issue refunds of overpayments to patients and payers and shall be responsible for reconciliation of the refund checking account to assure that all refund checks have been cashed. CLIENT shall promptly notify ACC of the receipt of cancelled checks upon which ACC shall rely to remove credit balances from CLIENT’s accounts receivable files. CLIENT shall be solely responsible for monitoring and surrendering unclaimed funds to the Treasurer of the State having escheat jurisdiction over any unclaimed payments.
7. CLIENT shall be responsible for assuring that all information required for physician enrollment, if performed by ACC, is provided timely, accurately and completely. ACC shall not be responsible for delays in physician enrollment and subsequent billing and payment delays or losses related to client omissions or delayed response by CLIENT.
8. CLIENT hereby acknowledges its independent and non-transferable duty to establish and remain aware of, and compliant with, all applicable federal and state laws and regulations, contractual rules and regulations, contracts, published notices and other applicable duties. Nothing in this Agreement shall be construed to abrogate, transfer, delegate or otherwise diminish CLIENT’s duties regarding awareness of, and compliance with, all applicable CLIENT duties.
9. CLIENT shall give ACC timely advance notice of any new payment contracts, HMO or PPO relationships and other contracts or market changes so that ACC may accommodate these changes, as necessary.
10. CLIENT shall ensure that any third party collection agency to which collection accounts are referred reports all collections and the source within five (5) business days of receipt.
ADDENDUM 2: COMPLIANCE
Each party to this Agreement has made a commitment to perform their respective duties in a legal and compliant manner, consistent with currently published and applicable federal, state and local laws, rules and regulations. In support of that
commitment, subject to the more express provisions (if any) of a Compliance Plan adopted by each party which is an “effective” compliance plan under the applicable standards promulgated by the Office of the Inspector General of the Department of Health and Human Services, as referred to in the Agreement each party agrees to the following:
1. At least once each year the parties will speak to discuss compliance and review their respective past and planned compliance activities.
2. Each party will conduct its own periodic risk assessment and advise their counterpart of any findings that may affect their counterpart’s compliance or performance under this Agreement.
3. Each party agrees that their counterpart may review their Compliance Program upon request.
4. Each party agrees to conduct appropriate background checks on all employees, contractors, agents and vendors to assure that all services are provided by individuals who have not been excluded by any government authority.
5. Each party agrees to maintain appropriate compliance records and assure their completeness, security and safety.
6. Each party agrees to pay specific attention to complying with the rules and regulations related to the following areas of widely known compliance risk:
a) Improper waiver or reduction of charges, deductibles and copayments;
b) Upcoding, unbundling, serial reporting and other coding violations;
c) Failure to completely and legibly document the services for which payment is being sought, including signature of the applicable supporting record(s);
d) Misuse of a provider number or misrepresentation of the identity of a provider of services;
e) Failure to repay overpayments or untimely refund of overpayments;
f) Seeking duplicate payment for the same service and/or from the same source;
g) Failure to maintain proper records of current and prior billing;
h) Failure to protect the confidentiality of patient information.
7. Each party agrees that, in the event that they become aware of a compliance concern that appears to be related to their
counterpart’s conduct, they will promptly communicate that concern to their counterpart. The party receiving notice will take prompt action to investigate the notice and will timely (within 30 days) report back to their counterpart on the status of the reported concern.
8. Each party specifically agrees that they will defer reporting any such concern to any payer, government agency or agent, or law enforcement organization unless they have complied with the above paragraph and remain concerned that their
counterpart’s response is inappropriate or more than thirty days have elapsed without any response. It is understood that
only in cases where a party has firm, credible evidence of deliberate, willful or criminal misconduct will they consider immediate reporting to anyone other than their counterpart.
9. Nothing in this paragraph shall be construed to infer or imply a duty or expectation that any party will knowingly conceal or participate in any misconduct, or allow any misconduct to continue.
10. Each party agrees to separately responsible for their respective compliance-related legal and consulting expenses.
11. Notwithstanding anything to the contrary in this Agreement, the parties agree that to the extent required by ACC in connection with maintenance of an effective Compliance Plan:
A. ACC may decline to submit any claim not supported by appropriate documentation (as reasonably determined by ACC), which documentation shall be available for review and audit. ACC shall have an affirmative duty to provide CLIENT with timely notice of any such decision, including their basis and a list of the affected claims. CLIENT shall have an affirmative duty to timely respond to such notice and cooperate in the resolution thereof.
B. ACC may take appropriate steps to resolve, or to advise CLIENT to resolve, overpayments or credit balances in a timely fashion. CLIENT will comply with the reasonable suggestions of ACC.
C. If ACC discovers evidence of misconduct by CLIENT relating to billing, ACC may refrain from submitting questionable claims and notify CLIENT of its determination in writing. If ACC discovers credible evidence of CLIENT’s continued misconduct following such a notice or discovers willful, deceptive, flagrant, fraudulent or abusive conduct by CLIENT, ACC may (i) refrain from submitting any claims ACC determines to be false or inappropriate, (ii) terminate this Agreement, without penalty, immediately on written notice, and/or (iii) report the misconduct to appropriate State and/or Federal authorities.
D. In addition, CLIENT will take reasonable steps to comply with any audit or investigation of ACC relating to an effective Compliance Plan and will appoint a senior member of CLIENT’s Practice with responsibility and appropriate internal authority to work with ACC as to compliance with State and/or Federal laws and regulations relating to billing.