Common Contracts

3 similar Financial Agreement contracts

FINANCIAL AGREEMENT AND ASSIGNMENT OF BENEFITS
Financial Agreement • February 3rd, 2020

Center For Sight, P.L., Laser and Surgical Services at CFS, LLC and Montgomery Eye Center, Inc. (CFS) are privately-owned medical facilities that provide medical services on a fee-for-service basis. CFS relies solely on insurance reimbursement and patient payment(s) for services rendered in good faith. CFS receives no federal, state or other third-party funding; as such, CFS does not have provision for providing on-going indigent care. The following Financial Agreement is developed in accordance with Office of Inspector General (OIG) guidelines as well as all applicable State and Federal reimbursement guidelines.

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FINANCIAL AGREEMENT AND ASSIGNMENT OF BENEFITS
Financial Agreement • February 3rd, 2020

Center For Sight, P.L., Laser and Surgical Services at CFS, LLC and Montgomery Eye Center, Inc. (CFS) are privately-owned medical facilities that provide medical services on a fee-for-service basis. CFS relies solely on insurance reimbursement and patient payment(s) for services rendered in good faith. CFS receives no federal, state or other third-party funding; as such, CFS does not have provision for providing on-going indigent care. The following Financial Agreement is developed in accordance with Office of Inspector General (OIG) guidelines as well as all applicable State and Federal reimbursement guidelines.

FINANCIAL AGREEMENT AND ASSIGNMENT OF BENEFITS
Financial Agreement • January 3rd, 2020

Center For Sight, P.L., Laser and Surgical Services at CFS, LLC and Montgomery Eye Center, Inc. (CFS) are privately-owned medical facilities that provide medical services on a fee-for-service basis. CFS relies solely on insurance reimbursement and patient payment(s) for services rendered in good faith. CFS receives no federal, state or other third-party funding; as such, CFS does not have provision for providing on-going indigent care. The following Financial Agreement is developed in accordance with Office of Inspector General (OIG) guidelines as well as all applicable State and Federal reimbursement guidelines.

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