What is a Provider Agreement in a Medical Billing Company

The health care industry runs on a long chain of medical billing and claims to compensate health care providers for their services. However, managing bills and filing claims is not a cakewalk due to a long list of guidelines laid by the federal government under various acts like HIPAA, SSA, etc. The hospitals are required to follow a specific set of guidelines to file medical claims and bill patients for various medical situations.

For example, the health care provider must know the correct use of modifiers, and medical codes while generating bill and filling Medicare claims. One can’t use modifier-25 to represent ‘partially reduced services’ while filing claims. The correct modifier to represent partially reduced services in the medical claims form is modifier-52. CMS clearly states that modifier-52 should be “under certain circumstances a service or procedure is partially reduced or eliminated at the physician’s discretion.”

It is quite clear that medical billing is not an easy process due to various technicalities and guidelines involved in fulfilling it. Therefore, to avoid any error in the medical billing and claims process, the health care industry is dependent on medical billing companies for accurate billing. This is where the provider agreement comes in.

Definition of Provider Agreement

In a medical billing company provider agreement or service agreement is a legal document outlining the services and the terms under which the payment for those services is rendered. The service agreement obliges the health care provider to compensate for the medical billing company services without any failure. This means the health care provider cannot terminate the company’s services without compensating billing services.

In a few words, the provider agreement in a medical billing company is just the contact for medical billing between the health care provider and the billing company. A good medical billing company offers unmatched billing services by designing a service contract without any loopholes.

Elements of the Provider Agreement in Medical Billing Company

A good service agreement for medical billing must consist of the following elements:

• Billing Services Offered
• Billing Services not Offered
• Cost of Services and Terms to Calculate the Cost
• Day of Beginning of Services/Effective Dates
• Asking for Patient Information
• Details to forwarding Payments Received from Insurance Payers and Patients
• Patient Privacy
• No-Responsibility for Previously Billing Errors
• Role/Responsibilities of the Client
• Role/Responsibilities of the Medical Billing Company
• Agreement Termination Conditions
• Software Compatibility

Benefits of Provider Agreement in Medical Billing Company

• Compensation
• Transparency
• Correct Billing
• Saves Time
• Increased Chances of Maximum Reimbursement
• Reliable Services

The medical billing company and the health care provider must consult a legal expert to ensure the efficacy of the agreement. A good provider agreement in a medical billing company is designed to meet the requirements of the health care provider and avoid the billing problems that are likely to occur due to any issue. Both parties agree to fulfill their roles and responsibilities to make the billing process effective. This helps in preventing any fraud and/or failure of fulfilling responsibilities.