Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints the Management Company to be the agent of the Medical Group during the Term, to perform the following duties and for those purposes incidental thereto: (i) to xxxx patients and third party payors in the Medical Group's name and on its behalf; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of the Medical Group as of such termination date for a period of ninety (90) days thereafter. (b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners (the "Authorized Partners") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group to perform its duties as agent under this Section 3.6 and its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure of an Authorized Partner to sign the Documents in a timely manner. (c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law. (d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group: (i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required. (ii) Submit claims utilizing electronic billing submission, whenever appropriate. (iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee. (iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency. (v) Write-off account balances according to criteria approved by the Operations Committee. (vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee. (vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California workers' compensation fee schedule. (viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy. (ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments from the PPOs and HMOs are in compliance with the contract with the Medical Group. (x) With respect to capitation fee contracts with HMOs, the Management Company shall -- (A) Follow-up to ensure that payments to the Medical Group are made on a timely basis; (B) Review and audit enrollment data provided by the HMO to ensure that Medical Group is being compensated for the proper number of lives enrolled. (xi) With respect to lien accounts, the Management Company shall -- (A) Ensure that appropriate documents are signed and agreed to initially as between Medical Group, attorney and patient; (B) Follow-up on a regular basis as to the status of the account; and (C) Apply the policies of the Operations Committee in resolving open account balances. (xii) With respect to student athlete accounts, the Management Company shall coordinate insurances and other information in compliance with the policy of the Operations Committee. (xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Group, if warranted, and to ensure that amounts not returned are verified and audited for appropriateness. (xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate. (xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, are accounted for, monitored, followed-up, and ultimately collected.
Appears in 2 contracts
Samples: Management Services Agreement (BMJ Medical Management Inc), Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. On behalf of and for the account of Medical Group, Business Manager shall have the exclusive right to establish and maintain, on behalf of Medical Group, all credit and billing and collection policies and procedures, and shall coordinate and supervise Medical Group personnel to ensure the timely billing and collection of all professional and other fees for all billable Medical Services provided by Medical Group or Physicians. Business Manager shall advise and consult with Medical Group regarding the fees for Medical Services provided by Medical Group; it being understood, however, that Business Manager shall establish the fees to be charged for Medical Services. In connection with the billing and collection services to be provided hereunder, and throughout the Term (and thereafter as provided in Section 7.3), Medical Group hereby grants to Business Manager an exclusive special power of attorney and appoints Business Manager as Medical Group's exclusive true and lawful agent and attorney-in-fact, and Business Manager hereby accepts such special power of attorney and appointment, for the following purposes:
(a) The To supervise and coordinate the billing of Medical Group's patients, in the name of Medical Group's and on behalf of Medical Group hereby irrevocably designates and appoints the Management Company to be the agent of the for all billable Medical Services provided by Medical Group during to patients.
(b) To supervise and coordinate the Term, to perform the following duties and for those purposes incidental thereto: (i) to xxxx patients and third party payors billing in the Medical Group's name and on its behalf; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patientsbehalf, as applicable, all claims for reimbursement or indemnification from Blue Cross and Shield/Blue Shield organizationsCross, insurance companies, health care plans, Medicare, Medicaid, HMO's and any and all other third party payorspayors or fiscal intermediaries for all covered billable Medical Services provided by Medical Group to patients.
(c) To ensure the collection and receipt in Medical Group's name and on Medical Group's behalf, all accounts receivable generated by such billxxxx xxx claims for reimbursement that have not been purchased by Business Manager, to administer such accounts including, but not limited to, (i) extending the time of payment of any such accounts for cash, credit or otherwise; (ivii) to take possession discharging or releasing the obligors of and deposit into any such bank accounts; (the "Medical Group Bank"iii) as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical GroupPolicy Board, which consent may be withheld by suing, assigning or selling at a discount such accounts to collection agencies; or (iv) with the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group Policy Board, taking other measures to collect any accounts and monies owed to require the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of the Medical Group as of such termination date for a period of ninety (90) days thereafter.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners (the "Authorized Partners") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group to perform its duties as agent under this Section 3.6 and its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure payment of an Authorized Partner to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable lawany such accounts.
(d) Without limiting To deposit all amounts collected in Medical Group's name and on behalf
(e) To take possession of, endorse in the generality name of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, and deposit into the Medical Group Account any notes, checks, money orders, insurance payments, and any other instruments received in payment for Medical Services.
(f) To sign checks, drafts, bank notes or other instruments on behalf of Medical Group, and to make withdrawals from the Medical Group Account for payments specified in this Management Services Agreement and as requested from time to time by Medical Group. Upon request of Business Manager, Medical Group shall execute and deliver to the financial institution wherein the Medical Group is maintained, such additional documents or instruments as may be necessary to evidence or effect the special and limited power of attorney granted to Business Manager by Medical Group pursuant to this Section 4.8 or pursuant to Section 4.9 of this Management Services Agreement. The special and limited power of attorney granted herein shall be coupled with an interest and shall be irrevocable except with Business Manager's written consent. The irrevocable power of attorney shall expire on the later of when this Management Services Agreement has been terminated, when all in a timely manner and accounts receivable purchased by Business Manager have been collected, or when all Management Fees due to Business Manager have been paid. If Business Manager assigns this Management Services Agreement in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionallyits terms, the Management Company then Medical Group shall provide the following services which are currently being provided by or on behalf execute a power of attorney in favor of the Medical Group:
(i) Receive assignee and collect from patients at in the time form of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information requiredExhibit 4.8 attached hereto.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments from the PPOs and HMOs are in compliance with the contract with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --
(A) Follow-up to ensure that payments to the Medical Group are made on a timely basis;
(B) Review and audit enrollment data provided by the HMO to ensure that Medical Group is being compensated for the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall --
(A) Ensure that appropriate documents are signed and agreed to initially as between Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Group, if warranted, and to ensure that amounts not returned are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, are accounted for, monitored, followed-up, and ultimately collected.
Appears in 2 contracts
Samples: Management Services Agreement (Raytel Medical Corp), Management Services Agreement (Raytel Medical Corp)
Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints acknowledges that ownership of all Accounts (as hereinafter defined) is transferred by the Medical Group to the Management Company as provided in greater detail in Section 5.1 of this Agreement. In order to be facilitate the agent collection of the Medical Group during Accounts, the Term, to perform the following duties and for those purposes incidental thereto: Management Company shall (i) to xxxx patients and third party payors in the Medical Group's name and on its behalfname; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's HMOs, and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts Accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its their fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of the Medical Group as of such termination date for a period of ninety (90) days thereafter.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners or other authorized signatories (the "Authorized Partners") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group Company to perform its duties as agent under take the actions specified in this Section 3.6 and to perform its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to take the actions specified herein or to perform the Management Services to the extent caused by the failure of an Authorized Partner to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms mechanics for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes changes, if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California Florida workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments received from the PPOs and HMOs are in compliance with the contract their respective contracts with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --shall:
(A) Follow-up to ensure that payments to the Medical Group are made on a timely basis;; and
(B) Review and audit enrollment data provided by the HMO to ensure that the Medical Group is being compensated for the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall --shall:
(A) Ensure that appropriate documents are signed and agreed to initially as between the Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances insurance and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Group, if warranted, and to ensure that amounts not returned are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue revenues related to depositions, record review, review and court appearances, athletic teams services, appearances are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints the Management Company to be the agent of the Medical Group during the Term, to perform the following duties and for those purposes incidental thereto: (i) to xxxx patients and third party payors in the Medical Group's name and on its behalf; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of the Medical Group as of such termination date for a period of ninety (90) days thereafter.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners (the "Authorized Partners") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group to perform its duties as agent under this Section 3.6 and its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure of an Authorized Partner to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments from the PPOs and HMOs are in compliance with the contract with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --
(A) Follow-up to ensure that payments to the Medical Group are made on a timely basis;
(B) Review and audit enrollment data provided by the HMO to ensure that Medical Group is being compensated for the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall --
(A) Ensure that appropriate documents are signed and agreed to initially as between Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Group, if warranted, and to ensure that amounts not returned are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, and royalties payable to Xxxxxxx X. Xxxxxx, M.D., are accounted for, monitored, followed-followed- up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. (a) The Ownership of all Accounts (as hereinafter defined) shall at all times remain the sole and exclusive property of the Medical Group hereby irrevocably designates and appoints Group. In order to facilitate the collection of the Accounts, the Management Company shall continue to be the agent of the Medical Group during the Term, to perform the following duties and for those purposes incidental thereto: (i) to xxxx patients and third party payors in the Medical Group's name and on its behalfname; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's HMOs, and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts Accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its their fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant Medical Group shall promptly turn over to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of for deposit into the Medical Group as Collections Account in accordance with this Agreement all checks and other payments received by the Medical Group or by any of such termination date its stockholders or employees from any patient or third party payor for a period of ninety (90) days thereafterMedical Group Services rendered during the Term.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners signatories (the "Authorized PartnersSignatories") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group Company to perform its duties as agent under take the actions specified in this Section 3.6 and to perform its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner Signatory is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure of an Authorized Partner Signatory to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms mechanics for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes changes, if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations CommitteeMedical Group.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations CommitteeMedical Group.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California state workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee Medical Group policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments from the such PPOs and HMOs are in compliance with the contract their respective contracts with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --:
(A) Follow-up to ensure that payments to the Medical Group are made on a timely basis;; and
(B) Review and audit enrollment data provided by the HMO to ensure that Medical Group is being compensated for the capitation payments are based on the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall --shall:
(A) Ensure that appropriate documents are signed and agreed to initially as between the Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances insurance and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Grouppaid, if warranted, and to ensure that amounts not returned paid are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints acknowledges that ownership of all Accounts (as hereinafter defined) is transferred by the Medical Group to the Management Company as provided in greater detail in Section 5.1 of this Agreement. In order to be facilitate the agent collection of the Accounts, the Management Company shall through its personnel retained to work in the offices of the Medical Group during the Term, to perform the following duties and for those purposes incidental thereto: (i) to xxxx patients and third party payors in the Medical Group's name and on its behalfname; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's HMOs, and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts Accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its their fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant Medical Group shall promptly turn over to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of for deposit into the Medical Group as Collections Account in accordance with this Agreement all checks and other payments received by the Medical Group or by any of such termination date its partners, equity owners or employees from any patient or third party payor for a period of ninety (90) days thereafterMedical Group Services rendered during the Term.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners signatories (the "Authorized PartnersSignatories") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group Company to perform its duties as agent under take the actions specified in this Section 3.6 and to perform its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner Signatory is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure of an Authorized Partner Signatory to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with applicable law and parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms mechanics for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes changes, if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California Florida workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments received from the such PPOs and HMOs are in compliance with the contract their respective contracts with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --:
(A) Follow-up to ensure that payments to the Medical Group are made on a timely basis;; and
(B) Review and audit enrollment data provided by the HMO to ensure that Medical Group is being compensated for the capitation payments are based on the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall --shall:
(A) Ensure that appropriate documents are signed and agreed to initially as between the Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances insurance and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned paid to the Medical Group, if warranted, and to ensure that amounts not returned paid are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints acknowledges that ownership of all Accounts (as hereinafter defined) is transferred by the Medical Group to the Management Company as provided in greater detail in Section 5.1 of this Agreement. In order to be facilitate the agent collection of the Medical Group during Accounts, the Term, to perform the following duties and for those purposes incidental thereto: Management Company shall (i) to xxxx patients and third party payors in the Medical Group's name and on its behalfname; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's HMOs, and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts Accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its their fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of the Medical Group as of such termination date for a period of ninety (90) days thereafter.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners or other authorized signatories (the "Authorized Partners") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group Company to perform its duties as agent under take the actions specified in this Section 3.6 and to perform its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to take the actions specified herein or to perform the Management Services to the extent caused by the failure of an Authorized Partner to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms mechanics for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes changes, if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California Florida workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments received from the PPOs and HMOs are in compliance with the contract their respective contracts with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --shall:
(Aa) Follow-up to ensure that payments to the Medical Group are made on a timely basis;
(Bb) Review and audit enrollment data provided by the HMO to ensure that the Medical Group is being compensated for the proper number of lives enrolled; and
(c) Review and audit appropriateness of withholds and reserves with respect to specialty risk pools.
(xi) With respect to lien accounts, the Management Company shall --shall:
(Aa) Ensure that appropriate documents are signed and agreed to initially as between the Medical Group, attorney and patient;
(Bb) Follow-up on a regular basis as to the status of the account; and
(Cc) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances insurance and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Group, if warranted, and to ensure that amounts not returned are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue revenues related to depositions, record review, review and court appearances, athletic teams services, appearances are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints acknowledges that ownership of all Accounts (as hereinafter defined) is transferred by the Medical Group to the Management Company as provided in greater detail in Section 5.1 of this Agreement. In order to be facilitate the agent collection of the Accounts, the Medical Group during hereby authorizes the Term, to perform the following duties and for those purposes incidental thereto: Management Company (i) to xxxx patients and third party payors in the Medical Group's name and on its behalfname; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's HMOs, and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of the Medical Group as of such termination date Accounts for a period of ninety (90) days thereafter.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners officers (the "Authorized PartnersOfficers") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group Company to perform its duties as agent under this Section 3.6 and its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner Officer is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure of an Authorized Partner Officer to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments from the PPOs and HMOs are in compliance with the contract with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --
(A) Follow-up to ensure that payments to by the Medical Group HMOs are made on a timely basis;
(B) Review and audit enrollment data provided by the HMO to ensure that Medical Group is being compensated for the capitation payments are based on the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall --
(A) Ensure that appropriate documents are signed and agreed to initially as between Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Grouppaid, if warranted, and to ensure that any withheld amounts that are not returned paid are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints the Management Company to be the agent of the Medical Group during the Term, to perform the following duties and for those purposes incidental thereto: (i) For Practice Sites which have obtained IDTF status, to the extent permitted by law and at Administrator's sole discretion, Administrator shall directly xxxx and collect from patients, insurance companies, Managed Care Payors and other third-party payors for professional supervision and interpretation fee charges and technical fee charges incurred in connection with services rendered at the Premises (the "Facility Charges") both prior to and during the term of this Agreement. Administrator will deposit all collections from Facility Charges directly into the Administrator Account.
(ii) To the extent required by law or if Administrator does not directly xxxx and collect Facility Charges pursuant to Section 3.2(b)(i) above, Administrator shall, in the name of and on behalf of the Group, xxxx patients, insurance companies, Managed Care Payors, and other third-party payors and collect fees in connection with the services performed at the Premises or any Practice Site(s) (including fees generated by both the Technical Operations and the Professional Operations), whether rendered prior to or during the term of this Agreement, except for the Facility Charges to the extent Administrator bills and collects such Facility Charges pursuant to subsection (b)(i) above. Administrator will deposit all collections from this subsection (b)(ii) directly into the Deposit Account. The Group hereby appoints Administrator for the term of this Agreement to be its true and lawful attorney-in-fact, for the following purposes:
(A) to xxxx patients patients, insurance companies, Managed Care Payors, and third other third-party payors in the Medical Group's name and on its behalf; ;
(iiB) to collect accounts receivable resulting from such billing; billing not otherwise purchased by Administrator (iiias provided for in Section 3.2(e) hereof) in the Group's name and on its behalf;
(C) to receive payments and prepayments on behalf of the Group from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, prepayments received from health care plans, Medicare, Medicaid, HMO's and any Managed Care Payors and all other third third-party payors; ;
(ivD) to ensure the collection and receipt in Administrator's name and for Administrator's account of all accounts receivable of the Group purchased by Administrator, and to deposit such collections into the Deposit Account;
(E) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group endorse in the name of the Medical Group and deposit into the Deposit Account (and/or in the "Medical Group Collections Account")name of an individual physician, such payment intended for purpose of payment of professional fees related to the Group) any and all notes, checks, money orders, insurance payments, cash, cash equivalents payments and other instruments received for Medical Group Servicesin payment of accounts receivable not otherwise purchased by Administrator; and and
(vF) to initiate with upon the prior consent of the Medical Group, which consent may shall not be unreasonably withheld by or delayed, to initiate the Medical Group in its sole and absolute discretion, institution of legal proceedings in the name of the Medical Group or a Physician Employee to collect any accounts and monies owed to the Medical GroupGroup or the Physician Employee, to enforce the rights of the Medical Group or the Physician Employee, as a the case may be, as creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its their fiscal intermediaries) as third-party payors.
(iii) The Group hereby appoints Administrator as its true and lawful attorney-in-fact to deposit into the Deposit Account all Professional Revenues and Technical Revenues collected by Administrator as provided for in Section 3.2(b)(ii). The Management CompanyGroup covenants, in and shall cause all Physician Employees and Physician Extender Employees to covenant, to forward any payments received with respect to any Professional Revenues or Technical Revenues generated for services provided by the Group or any of its capacity Physician Employees and Physician Extender Employees to Administrator for deposit. All owners of the Deposit Account shall execute a revocable standing transfer order (the "Transfer Order") under which the bank maintaining the Deposit Account shall transfer the entire balance of the Deposit Account to a separate bank account owned solely by Administrator (the "Administrator Account") on a daily basis. The Group and Administrator hereby agree to execute from time to time such documents and instructions as agent pursuant shall be required by the bank maintaining the Deposit Account and mutually agreed upon to effectuate the foregoing provisions and to extend or amend such documents and instructions. Any action by the Group that materially interferes with the operation of this paragraphSection, shall including but not limited to, any failure to deposit or to have Administrator deposit any duties Professional Revenues and/or Technical Revenues (other than the collections related to the Facility Charges) into the Deposit Account, any withdrawal of any funds from the Deposit Account not authorized by the express terms of this Agreement or responsibilities except those expressly set forth in clauses any other written agreement executed by each of the parties, or any revocation of or attempt to revoke the Transfer Order (i) through (v) above. Following otherwise than upon expiration or termination of this Agreement), will constitute a breach of this Agreement and will entitle Administrator, in addition to any other remedies it may have at law or in equity, to seek a court ordered assignment of the Management Company rights provided to Administrator pursuant to subparagraph (i) above.
(iv) All monies collected pursuant to Section 3.2(b)(ii) above shall continue be accounted for by Administrator as being distinctly attributable to the Group.
(v) The Group may perform the functions or exercise the rights set forth in Section 3.2(b)(ii) only with the prior written consent of Administrator. The Group shall execute such documents in form and substance as approved by Administrator and its legal counsel to permit Administrator to exercise the rights and powers granted to Administrator pursuant to this Section 3.2(b). The Group shall cooperate with, and at the request of Administrator shall provide reasonable assistance to, Administrator with the functions set forth herein. In the performance of the services described in this Section 3.2(b), Administrator shall use commercially reasonable efforts to collect the accounts receivable of the Medical Group as of such termination date for a period of ninety (90) days thereafter.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners (the "Authorized Partners") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") payments billed on behalf of the Medical Group that are necessary for the Management Group pursuant to perform its duties as agent under this Section 3.6 and its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure of an Authorized Partner to sign the Documents in a timely manner.
subsection (c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOsb)(ii) and Health Maintenance Organizations (HMOs)shall comply with all applicable Managed Care Contracts and all applicable laws, the Management Company shall determine that payments from the PPOs rules and HMOs are in compliance with the contract with the Medical Groupregulations.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --
(A) Follow-up to ensure that payments to the Medical Group are made on a timely basis;
(B) Review and audit enrollment data provided by the HMO to ensure that Medical Group is being compensated for the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall --
(A) Ensure that appropriate documents are signed and agreed to initially as between Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Group, if warranted, and to ensure that amounts not returned are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Service Agreement (Radiologix Inc)
Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints acknowledges that ownership of all Accounts (as hereinafter defined) is transferred by the Medical Group to the Management Company as provided in greater detail in Section 5.1 of this Agreement. In order to be facilitate the agent collection of the Medical Group during Accounts, the Term, to perform the following duties and for those purposes incidental thereto: Management Company shall (i) to xxxx patients and third party payors in the Medical Group's name and on its behalfname; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's HMOs, and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts Accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its their fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of the Medical Group as of such termination date for a period of ninety (90) days thereafter.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners equity members or other authorized signatories (the "Authorized Partners") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group Company to perform its duties as agent under take the actions specified in this Section 3.6 and to perform its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to take the actions specified herein or to perform the Management Services to the extent caused by the failure of an Authorized Partner to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms mechanics for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes changes, if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California Pennsylvania workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments received from the PPOs and HMOs are in compliance with the contract their respective contracts with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --shall:
(A) Follow-up to ensure that payments to the Medical Group are made on a timely basis;; and
(B) Review and audit enrollment data provided by the HMO to ensure that the Medical Group is being compensated for the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall --shall:
(A) Ensure that appropriate documents are signed and agreed to initially as between the Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances insurance and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Group, if warranted, and to ensure that amounts not returned are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue revenues related to depositions, record review, review and court appearances, athletic teams services, appearances are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. (a) Ownership of all accounts receivable (other than those accrued as of the Effective Date) and other rights to payment arising from the provision by the Medical Group of Medical Group Services and related services to the general public during the Term (the "Accounts") will at all times remain the sole and exclusive property of the Medical Group. The Medical Group hereby irrevocably designates and appoints the Management Company as its true and lawful attorney-in-fact for the purposes described in this section for the term of this Agreement. The Management Company will create and maintain a depository account in the name of Medical Group with a banking institution selected by the Management Company (the "Medical Group Collections Account"). The Medical Group authorizes the Management Company to be make withdrawals from the agent Medical Group Collections Account, including withdrawals for payment of the Management Fee. If necessary, additional accounts in the names of the Medical Group during Physicians may be created for the Termpurpose of collecting payments in compliance with Medicare and Medicaid law. The Medical Group grants the Management Company, as its attorney-in-fact, the right to perform the following duties and for those purposes incidental thereto: (i) to xxxx patients and third party payors in the Medical Group's name and on its behalfname; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's and any and all other third party payorspayors (including but not limited to insurers, self-insured employers and government programs); (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designatesof, in an account established by the Medical Group endorse in the name of the Medical Group (Group, and deposit into the "Medical Group Collections Account"), Account any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to make payments for accounts payable on behalf of the Medical Group, including payment of the Management Fee; and (vi) initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts Accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its their fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant Medical Group will immediately forward to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of for deposit into the Medical Group as Collections Account all checks and other payments received by the Medical Group or by any of such termination date its partners, equity owners or employees from any patient or third party payor for a period of ninety (90) days thereafterMedical Group Services rendered during the Term.
(b) From time to time at the Management Company's request, the Medical Group shall will make available to the Management Company one or more authorized partners (the "Authorized Partners") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are as may be necessary for the Management Group Company to take the actions specified in this Section 3.5 and to perform its duties as agent under this Section 3.6 and its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure of an Authorized Partner to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall will submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law; provided that the Medical Group meets its obligations regarding billing and patient encounter information described in Section 7.3.
(d) Without limiting the generality of the foregoing, The Medical Group hereby grants the Management Company shall xxxx patients, xxxx and submit claims a security interest in its Accounts to third party payors, perform appropriate coding for each xxxx, and collect secure all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
's obligations under this Agreement. The Medical Group will execute a financing statement (ithe "Financing Statement") Receive and collect from patients at for the time benefit of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments the Management Company necessary for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over Management Company to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committeeperfect its interest therein. The Management Company shall also follow-up on will have the performance of right to grant to any lender (the outside collection agencies "Lender") a lien and make changes if necessary, security interest in and additionally shall reconcile each account turned over with respect to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance Accounts, together with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California workers' compensation fee schedule.
(viii) Apply "insurance only" all books, records, computer information and other courtesy write-offs in compliance with Operations Committee policy.
general intangibles relating thereto (ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOscollectively, the "Collateral"), as security for the obligations of the Management Company shall determine to the Lender. The Medical Group acknowledges that payments from the PPOs and HMOs are in compliance with Lender is a third party beneficiary of the contract with the Medical Group.
(x) With respect benefits granted to capitation fee contracts with HMOs, the Management Company shall --
(A) Follow-up under this Section 3.5(d). The Medical Group will cooperate with the Lender as reasonably requested by the Lender if the Lender seeks to ensure that payments enforce its rights and remedies under its agreement with the Management Company, including granting the Lender access, to the extent permitted by law, to all books and records associated with the Collateral. Neither the Management Company nor the Lender will be required to give the Medical Group are made on a timely basis;
(B) Review and audit enrollment data provided by any notice in connection with any loan or related financing arrangements affecting the HMO to ensure that Medical Group is being compensated for the proper number of lives enrolledAccounts or other Collateral.
(xi) With respect to lien accounts, the Management Company shall --
(A) Ensure that appropriate documents are signed and agreed to initially as between Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Group, if warranted, and to ensure that amounts not returned are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints acknowledges that ownership of all Accounts (as hereinafter defined) is transferred by the Medical Group to the Management Company as provided in greater detail in Section 5.1 of this Agreement. In order to be facilitate the agent collection of the Accounts, the Medical Group during hereby authorizes the Term, to perform the following duties and for those purposes incidental thereto: Management Company (i) to xxxx patients and third party payors in the Medical Group's name and on its behalfname; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's HMOs, and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its fiscal intermediaries) as third-third party payors. The Medical Group shall promptly turn over to the Management Company, Company for deposit into the Medical Group Collections Account in accordance with this Agreement all checks and other payments received by the Medical Group or by any of its capacity as agent pursuant to this paragraph, shall not have shareholders from any duties patient or responsibilities except those expressly set forth in clauses (i) through (v) abovethird party payor for Medical Group Services rendered hereunder. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of the Medical Group as of such termination date Accounts for a period of ninety (90) days thereafterthereafter (and any amounts collected during such period shall be considered as Collections under this Agreement).
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners representatives (the each, an "Authorized PartnersSignatory") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group Company to perform its duties as agent under this Section 3.6 and its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner Signatory is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure of an Authorized Partner Signatory to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). The Management Company may discharge its billing and collection responsibilities hereunder by arranging for such duties to be carried out by the billing service that furnished such services to the Medical Corporation immediately prior to the date hereof, or by such other billing service as the Management Company may in its discretion select. Additionally, the Management Company shall provide or arrange for the provision of the following services which are currently being provided by or on behalf of the Medical Groupservices:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also , follow-up on the performance of the outside collection agencies and make changes if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California state workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments from the PPOs and HMOs are in compliance with the contract with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall HMOs --
(A) Follow-up to ensure that payments to by the Medical Group HMOs are made on a timely basis;
(B) Review and audit enrollment data provided by the HMO to ensure that Medical Group is being compensated for the capitation payments are based on the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall accounts --
(A) Ensure that appropriate documents are signed and agreed to initially as between Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Grouppaid, if warranted, and to ensure that any withheld amounts that are not returned paid are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)
Billing and Collection. (a) The Medical Group hereby irrevocably designates and appoints acknowledges that ownership of all Accounts (as hereinafter defined) is transferred by the Medical Group to the Management Company as provided in greater detail in Section 4.1 of this Agreement. In order to be facilitate the agent collection of the Medical Group during Accounts, the Term, to perform the following duties and for those purposes incidental thereto: Management Company shall (i) to xxxx patients and third party payors in the Medical Group's name and on its behalfname; (ii) to collect accounts receivable resulting from such billing; (iii) to receive payments and prepayments from the Medical Group's patients, Blue Cross and Blue Shield organizations, insurance companies, health care plans, Medicare, Medicaid, HMO's HMOs, and any and all other third party payors; (iv) to take possession of and deposit into such bank (the "Medical Group Bank") as the Medical Group designates, in an account established by the Medical Group in the name of the Medical Group (the "Medical Group Collections Account"), any and all checks, insurance payments, cash, cash equivalents and other instruments received for Medical Group Services; and (v) to initiate with the consent of the Medical Group, which consent may be withheld by the Medical Group in its sole and absolute discretion, legal proceedings in the name of the Medical Group to collect any accounts Accounts and monies owed to the Medical Group, to enforce the rights of the Medical Group as a creditor under any contract or in connection with the rendering of any service, and to contest adjustments and denials by governmental agencies (or its their fiscal intermediaries) as third-party payors. The Management Company, in its capacity as agent pursuant Medical Group shall promptly turn over to this paragraph, shall not have any duties or responsibilities except those expressly set forth in clauses (i) through (v) above. Following termination of this Agreement, the Management Company shall continue to use reasonable efforts to collect the accounts receivable of for deposit into the Medical Group as Collections Account in accordance with this Agreement all checks and other payments received by the Medical Group or by any of such termination date its partners, equity owners or employees from any patient or third party payor for a period of ninety (90) days thereafterMedical Group Services rendered during the Term.
(b) From time to time at the Management Company's request, the Medical Group shall make available to the Management Company one or more authorized partners signatories (the "Authorized PartnersSignatories") of the Medical Group to sign any letters, checks, instruments or other documents (the "Documents") on behalf of the Medical Group that are necessary for the Management Group Company to perform its duties as agent under take the actions specified in this Section 3.6 and to perform its other duties under this Agreement. If the Management Company notifies the Medical Group that an Authorized Partner Signatory is not signing the Documents in a timely manner, the Management Company shall not be liable for any failure to perform its duties as agent hereunder or for any failure to perform the Management Services to the extent caused by the failure of an Authorized Partner Signatory to sign the Documents in a timely manner.
(c) The Management Company represents and warrants to the Medical Group that it has sufficient knowledge and expertise in the area of billing for orthopedic and other medical services and ancillary services to be able to adequately perform the billing services required by the Medical Group hereunder. The Management Company shall submit all bills and manage the billing process on a timely basis in accordance with the terms of this Agreement and applicable law.
(d) Without limiting the generality of the foregoing, the Management Company shall xxxx patients, xxxx and submit claims to third party payors, perform appropriate coding for each xxxx, and collect all fees for professional and other services rendered and for items supplied to patients by the Medical Group, all in a timely manner and in accordance with parameters and criteria established by the Operations Committee (as hereinafter defined). Additionally, the Management Company shall provide the following services which are currently being provided by or on behalf of the Medical Group:
(i) Receive and collect from patients at the time of visit all appropriate payments and pre-payments, including co-pays, deductibles, payments for non-covered medical services, and deposits for surgeries (if applicable), and additionally shall obtain all appropriate insurance and other information required.
(ii) Submit claims utilizing electronic billing submission, whenever appropriate.
(iii) Perform delinquent account collection calls and other appropriate follow-up mechanisms mechanics for delinquent accounts of all insurance classifications, all in a timely fashion as determined by the Operations Committee.
(iv) Turn over to outside collection agencies all delinquent accounts satisfying the criteria established by the Operations Committee. The Management Company shall also follow-up on the performance of the outside collection agencies and make changes changes, if necessary, and additionally shall reconcile each account turned over to the summary data provided by the collection agency.
(v) Write-off account balances according to criteria approved by the Operations Committee.
(vi) Prepare claim reviews in accordance with criteria approved by the Operations Committee.
(vii) Xxxx workers' compensation medical services at rates equal to the most recently approved California state workers' compensation fee schedule.
(viii) Apply "insurance only" and other courtesy write-offs in compliance with Operations Committee policy.
(ix) With respect to discounted fee-for-service contracts with Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), the Management Company shall determine that payments from the such PPOs and HMOs are in compliance with the contract their respective contracts with the Medical Group.
(x) With respect to capitation fee contracts with HMOs, the Management Company shall --:
(A) Follow-up to ensure that payments to the Medical Group are made on a timely basis;; and
(B) Review and audit enrollment data provided by the HMO to ensure that Medical Group is being compensated for the capitation payments are based on the proper number of lives enrolled.
(xi) With respect to lien accounts, the Management Company shall --shall:
(A) Ensure that appropriate documents are signed and agreed to initially as between the Medical Group, attorney and patient;
(B) Follow-up on a regular basis as to the status of the account; and
(C) Apply the policies of the Operations Committee in resolving open account balances.
(xii) With respect to student athlete accounts, the Management Company shall coordinate insurances insurance and other information in compliance with the policy of the Operations Committee.
(xiii) With respect to amounts withheld by payors in compliance with contracts between the payor and the Medical Group, the Management Company shall follow-up on a timely basis to ensure that withheld amounts are returned to the Medical Grouppaid, if warranted, and to ensure that amounts not returned paid are verified and audited for appropriateness.
(xiv) Coordinate the timely payment of refunds to patients and third party payors when appropriate.
(xv) Ensure that revenue related to depositions, record review, court appearances, athletic teams services, are accounted for, monitored, followed-up, and ultimately collected.
Appears in 1 contract
Samples: Management Services Agreement (BMJ Medical Management Inc)