Revenue Cycle Management (“RCM”) Addendum

Revenue Cycle Management (RCM) Addendum

Effective as of October 1, 2024 (Version Number: 45566)

All terms not defined herein shall have the meaning ascribed to them in the DAS Standard Incorporated Terms and Conditions.

Revenue Cycle Management (“RCM”) - If the executed COF includes RCM in any form, the following additional terms and conditions apply:

DAS Obligations. DAS agrees to use its reasonable commercial efforts to provide the following for the Term of the Agreement:
1. DAS will use reasonable commercial efforts to perform billing and collection functions at or above standards maintained by the Medical Group Management Association (MGMA), to the extent of the information provided by Client.
2. DAS will produce all claims and billings in a manner that directs remittances to the Client’s designated location. Provided that Client has purchased patient call services and executed an agreement with DAS for patient statements, Client may refer any telephone communication related to such billing to DAS offices. DAS will be accessible to Client representatives (and its patients, if applicable) on normal business days from 8:30 a.m. to 5:00 p.m. (Eastern Time). If DAS accepts credit card or ACH payments on behalf of Client, such acceptance must be administered through a DAS approved third party merchant services vendor, for which Client will be invoiced directly from the third party or by DAS as Additional Charges (at DAS’s sole option). If Client does not purchase the DAS statement solution, Client may not refer patients to DAS; however, if Client does make such referral in violation of this provision, a $20 surcharge for each patient call will be payable by Client as Additional Charges.
3. DAS may, at its sole discretion and shall not be required to, enter any patient information needed to complete an account, including but not limited to name, address, social security, phone number, insurance information and any other information as needed to facilitate billing and collection services for Client.
4. DAS will use reasonable commercial efforts to review and monitor the claims information provided by Client for completeness, consistency and correctness, and will request and obtain from Client any and all additional information as may be required to file complete and accurate claims. To assist in this process, Client agrees to make patient information available, remotely, through its practice management and electronic health record system (“PM/EHR”) as provided by DAS. For the purpose of clarity, DAS monitoring is not a substitute for Client’s responsibility for completeness, consistency and accuracy of claims, which are Client’s sole responsibility.
5. DAS will not cause any third-party collection services to be performed on Client accounts until Client approves said referral. DAS will agree upon standard procedures with Client prior to recommending a referral for third party collection activity. If patient statements are sent, such statements will be administered through a DAS approved third party, for which Client will be invoiced directly from the third party or by DAS as Additional Charges (at DAS option). Whether or not patient invoices are sent, and/or whether or not balances are approved for collections, DAS may write off all uncollected balances (including insurance and patient balances) after 90 days without Client approval, unless DAS believes in its sole discretion that they are collectible.
6. DAS will provide, upon request, a monthly financial summary showing totals for the following: beginning A/R, charges, receipts, adjustments, ending A/R, number of procedures, and net collection %, and other reports as may be agreed by DAS from time to time. Provided that DAS has provided Client with its PM/EHR system, Client may also produce its own detail reports on demand from within the system, and has near real-time visibility.
7. DAS will make available to Client upon reasonable request, at Client’s sole expense, any and all information or documentation directly related to any or all of their own patient accounts receivable.
8. DAS will process denial reconsiderations on all denied claims, additional payment requests for underpaid claims, and will file appeals as appropriate and necessary in DAS sole discretion.
9. DAS acknowledges that all monies collected on behalf of Client, whether in the form of checks, electronic funds transfers or otherwise, are the sole property of Client and will be collected solely in the name of Client.
10. Unless otherwise agreed, DAS shall have no responsibility or obligation to collect Client’s unpaid but billed claims or Client’s accounts receivable which, in either case, has remained uncollected for more than 365 days (“Old A/R”). The Parties may agree to have DAS collect such Old A/R as an Additional Charge, and DAS may write off all Old A/R in its sole discretion.
11. All services performed by DAS will be in compliance with applicable law and third party payer protocols and requirements; provided, however, that Client acknowledges and agrees that it is solely responsible for ensuring its compliance with all applicable federal, state, and local laws, including but not limited to fee-splitting laws and regulations governing healthcare providers. Client must ensure that its arrangements with DAS and/or any third parties comply all applicable law and that any necessary legal guidance is sought to avoid violations. DAS assumes no responsibility for Client’s compliance with these legal obligations.
12. DAS will uphold and abide by all rules, regulations, and laws as they pertain to privacy for Client with regard to Client confidential and proprietary information, and their patient records, unless specifically authorized to provide to any third party.
13. DAS will designate a specific individual to undertake primary responsibility and serve as primary contact person for Client with respect to the services contemplated by this Agreement.
Client Obligations. Client agrees as follows:
1. During the term of this agreement, Client will use no other company for the billing of their medical charges, will not use internal staff to bill their medical charges (unless specifically carved out by a fully executed Addendum), and agrees to pay DAS based on the total Client collections, including for all Providers no matter the service location, and whether or not actually collected by DAS (including if self-collected), unless specifically carved out by a fully executed Addendum.
2. Client acknowledges that DAS will rely on the information submitted by Client for use in the billing process. Client also agrees to provide DAS with timely access to all electronic payer portals and clearinghouses. Unless specifically agreed to by Company, Client agrees to contract with DAS for EDI services (through an EDI vendor as determined by DAS at its sole discretion) for each billing Provider; in such case, the EDI Addendum shall apply.
3. Client will enter all patient information needed to complete an account, including but not limited to name, address, social security, phone number, insurance information and any other information as needed to facilitate billing and collection services for Client. Client authorizes DAS to assist in this account completion, at DAS’s sole discretion. Client agrees and acknowledges that if patient information is not provided to DAS, not entered into the PM/EHR in a timely fashion, or entered into the PM/EHR system incorrectly, DAS shall not be responsible for any liability resulting therefrom, and DAS may not be able to perform its obligations under this Agreement.
4. Client will provide to DAS all new patient documentation necessary to establish an account, including legible copies of patient Information form, insurance cards, and hospital/nursing facilities face sheet, when applicable, in a timely fashion.
5. Client will enter into the PM/EHR system all clinical notes, diagnosis and CPT codes (including modifiers) at the time of patient visit; or not later than 3 business days thereafter. It is Client’s sole responsibility to enter all coding, including but not limited to entering modifiers. However, in the event that Client requests DAS to enter modifiers, and DAS agrees to do so (typically as an Additional Charge), any such rules for entering modifiers must be clearly specified in the Client protocol, and Client assumes all risks for the entry of such codes and modifiers. Client will provide DAS with unfettered access to its PM/EHR and EDI system(s), and not obstruct, delay, or otherwise inhibit DAS from filing or releasing claims on a timely basis. DAS may provide coding services as an Additional Service at an Additional Charge.
6. Client will enter all information directly into the PM/EHR system designated by DAS, and to the extent not able to be provided digitally, will have available on a daily basis; all superbills, charge forms (if applicable), record of direct payments received, and/or demographic information changes obtained as a result of patient interaction. In the event that DAS enters demographics and/or charges on behalf of Client, there shall be an Additional Charge of 2% of all charges entered for which DAS provided any manual entry.
7. Client will provide explanations of benefits (“EOBs”) to DAS within three (3) working days of having received them. DAS has the absolute right to audit all Client EOBs, and Client will provide access to its accounts on all payer online sites. Failure to provide DAS with timely EOBs will result in a five percent (5%) Additional Charge for all payments represented on such EOBs. In addition, DAS has the right to audit Client financial records pertaining to the bank accounts with deposits relating to any EOBs or patient payments. If Client (a) does not provide DAS with reasonable access to its online accounts; (b) does not allow DAS to complete an audit under this Section; or (c) is found to not have submitted EOBs or patient payments for more than two percent (2%) of all payments received by Client during any particular time period as determined by DAS, then at DAS’ option, DAS may either terminate this Agreement and the Client will owe as Additional Charges, at DAS’s sole discretion, (i) three (3) times the minimum monthly amount due times the number of months otherwise remaining in the Term, (ii) Client may be charged a surcharge of 50% times any otherwise applicable rate for the remainder of the Term, (iii) Client may be liable for any amounts found on EOBs and patient payments not produced; and (iv) Client may be liable for any other damages under this Agreement.
8. Notwithstanding anything to the contrary (unless pursuant to a specific addendum) Workers Compensation, personal injury, and auto insurance claims shall be billed at 25% of collections.
9. Client will otherwise comply with the terms of the Agreement, including the Schedules, Exhibits, and COFs.
10. Upon termination of services, or at DAS’ reasonable request at any time prior to termination, Client shall retrieve or authorize DAS to ship to Client or destroy, any records being stored by DAS, at Client’s sole expense, payable in advance. If Client does not provide such authorization or advance payment, DAS may take reasonable efforts to notify the appropriate state medical board of Client’s failure to adequately protect its records and provide an opportunity to cure prior to its destruction of such records prior to their destruction.
11. Client agrees and acknowledges that if patient information is not provided to DAS or entered into the PM/EHR in a timely fashion, DAS’s performance under this Agreement may suffer.
12. Client agrees to provide DAS with all necessary information, including but not limited to insurance remittances, diagnosis and CPT codes (including modifiers), patient information (such as name, address, social security number, phone number, and insurance details), and any other documentation required for DAS to perform the RCM services. Client further agrees to ensure that such information is accurate, complete, and provided in a timely manner through the agreed PM/EHR system. In addition, Client shall respond promptly to any requests for information or clarification from DAS. Client acknowledges that DAS's ability to perform its obligations under this Agreement depends on the receipt of complete and accurate information. Should Client fail to provide the necessary information or fail to respond to communications from DAS, DAS shall bear no responsibility for any delays or failures in collecting on claims, DAS’s obligations under this Agreement will be deemed suspended to the extent that its performance is hindered by Client’s non-compliance, and DAS may adjust or write off Client claims or deem such Client failure to be a Monetary Breach, each at DAS's sole discretion. DAS shall not be liable for any claims or losses arising from such failures.
Payment
1. Unless otherwise stated in COF, Client shall pay to DAS on a monthly basis commencing with the first month following the effective date of this Agreement an amount equal to the percentage on the COF, as a percent of all revenue collected or posted to Client accounts during the prior month (as otherwise adjusted herein), or Minimum Fee, whichever is greater. Additional Charges are over and above any Minimum Fee. Such service fees will be based on the collected or posted revenue of all physicians employed, affiliated with, and/or practicing at sites owned or operated by Client wherever located; and includes revenue collected for service performed at hospitals, assisted living facilities, nursing facilities, patient homes or other off-site locations. The Minimum Fee is based on the number of Providers represented on the COF; any additional Providers may require an additional Minimum Fee on a prorated basis. State Medicaid collections that are not permitted to be charged as a percent will be instead charged at a flat fee per claim submitted, subject to the Minimum Fee.
2. Unless otherwise stated on the COF, RCM Minimum Fees are considered MSC and shall be due on the first of the month for which services are performed. Fees for services in excess of the Minimum Fee shall be Additional Services Billed in Arrears within ten (10) days after the end of the month for which services are performed, and shall be deducted by way of ACH direct debit five (5) days following invoice. All other charges shall be billed and paid pursuant to one of the available payment options as stated on the Program Agreement or COF, as applicable. For so long as such RCM Services are in effect and Client makes all payments due thereunder, any RCM Discount shown on the COF(s) shall be in effect.
3. Upon termination or expiration of the RCM Services, DAS may, at its option: (a) continue to provide full collection efforts on all outstanding accounts receivable for ninety (90) days at the contracted percentage rate, and for which the Minimum Fee will be due per month during such time; or (b) immediately cease all collection efforts and charge two (2) times the Minimum Fee, in order to compensate for the claims previously billed by DAS but for which DAS did not receive remuneration. After such termination or expiration, Client is responsible for removing/deactivating DAS RCM staff credentials from any systems, portals, etc., and all outstanding accounts will be returned to the Client for final collection at Client’s sole expense.
4. In the event that the RCM Services are terminated prior to the term of this Agreement, for any or no reason, any RCM Discount shall immediately be void, and full pricing shall be in effect under the Standard Plan, with the UFC due being immediately due and payable by way of ACH direct debit, which amount shall be automatically, and without further notice, deducted. If Client terminates RCM Services prior to the end of the then current Term, Client shall be immediately liable for payment of, in addition to any other Early Termination fees, an Early Termination Fee equal to (a) $5,000 per Provider, plus (b) the greater of (i) the average monthly payment during the prior six months (or if in force less than six months, the number of months in force), or if Client was not substantially in compliance with Addendum section (b) above, the average monthly payment of the six months during the Term with the highest collection amounts; or (ii) the Minimum Fee; times the number of months remaining in the then current Term.
5. In the event that client changes its PM or EHR system at any time during the Term, DAS may, at its sole option: (a) charge a one-time setup charge at then prevailing rates; and (b) charge an additional MSC rate at then prevailing rates based on the new system deployed; or (c) terminate the Agreement, which will be considered an Early Termination by Client.
6. “Minimum Fee”, shall mean the Minimum as identified in the COF, or in the absence of that, the average monthly amount billed during the previous three (3) months.
Additional Services. Additional Services, including but not limited to coding, credentialing, contract negotiations, document storage and retrieval, and any other service not specifically enumerated herein, are not included in the price of RCM Services unless explicitly specified.
1. Coding Services. If the executed COF includes “Coding Services” as an Additional Service, then DAS will use its reasonable commercial efforts to provide coding services for documented procedures using appropriate HCPCS, CPT, ICD10 and/or modifiers as applicable, subject to the following additional Terms and Conditions:
  1. Client is responsible for providing complete visit notes/ medical records that have been signed and finalized;
  2. Medical Records must be completed, signed and uploaded within not more than 72 hours of the patient encounter;
  3. Certified coders will be assigned to all coding work; however, if coding is to be completed only for specific instances this must be clearly documented in the coding rules guide as part of the agreed written Client protocol, subject to mutually agreed modification from time to time;
  4. If Client would like to review codes (procedure, diagnosis, and/ or modifiers) prior to claim submission, Client must request such review in writing to DAS at least 72 business hours in advance;
  5. DAS does not guarantee payment for services rendered resulting from: (including without limitation) eligibility and benefit verification, authorization, coding services provided, or other factors;
  6. The Provider is ultimately responsible for correct and appropriate coding of claims; and
2. Value-based reimbursement, HCC, and other managed care coding are specifically excluded.
3. Credentialing Services. If the executed COF includes “Credentialing Services” as an Additional Service, then the following additional Terms and Conditions apply:
  1. Credentialing Services are only included as an Additional Service if they are specifically enumerated in an executed COF;
  2. DAS Credentialing services are for a minimum 12-month term (including renewals), and are non-refundable;
  3. Credentialing Services do not require other RCM services;
  4. DAS Responsibilities – DAS will use its reasonable commercial efforts to provide credentialing services as outlined below, subject to Client fulfilling all of its responsibilities:
    1. DAS will begin the credentialing process ONLY once all required setup information has been submitted to DAS by the Client.
    2. The Credentialing process may take up to 180 business days to complete, and the contracting process may take up to 90 business days to complete. Actual timeframes may vary and are dependent on the response time of applicable payers.
    3. After 12 months, any payers still in process will be Client’s responsibility. DAS will provide final status and Client may continue to follow the payer through to completion.
    4. DAS will create, process, and submit credentialing applications for all payers on the payer list.
    5. DAS will perform all follow-up statuses to ensure applications are being processed by the payer and to ensure timely delivery of contract approval.
    6. DAS does not guarantee that a contract will be issued for participation with any payer, as contracts are issued for participation at the sole discretion of the payer.
    7. DAS does not negotiate payer fees/rates.
    8. DAS will only reapply to panels once within the first six months from the date the agreement was signed.
    9. Should reapplication be denied, any appeal to a payer regarding a denied panel must be written and provided by the provider for DAS to submit.
    10. If Client has selected Medicare as one of the payers, please note that CMS requires Client to provide DAS access as an authorized official for PECOS; if not approved DAS cannot complete this payer.
  5. Client Responsibilities:
    1. Client is responsible for negotiating all payer fees and rates;
    2. Response time requirements:
      1. Client agrees to supply all requested documents within five business days from COF approval;
      2. Client agrees to respond to all DAS requests within two business days of receipt, and
      3. If missing or incomplete documents are not received within five business days, DAS will send a 10-day notice. After this 10-day period, if there is no activity, credentialing services will be terminated, however the Client will continue to be responsible for payments through the remainder of the Term;
    3. Client agrees to participate in weekly communication sessions with the assigned Credentialing Account Manager during at least the first 30 days of engagement;
    4. Client agrees to refrain from submitting any applications to any payers for any providers/ groups included on the Credentialing Protocol. Submission by both parties can cause multiple issues. Client understands that DAS will immediately terminate credentialing services should this occur, however the Client will continue to be responsible for payments through the remainder of the Term.
    5. No changes to the payer list can be made after 10 days from the date the COF and Credentialing Protocol have been signed. If changes are made to add additional payers to the list (to make the total for the package selected only), those changes must be submitted within the first 30 days following sign-up.
  6. All payers added or Additional Services requested that are not included in the purchased package or are added after the initial 30 days post sign-up would require a new and separate agreement for an additional fee. The fee is based on the service requested and any discounts provided are at the sole discretion of DAS.
Other Consents, Authorizations and Limitations. Client authorizes and consents to DAS’ access to any and all records pertaining to Client's provision of medical services, and payments therefore, including but not limited to any such records available from any other health care provider and any payer of benefits, including but not limited to Medicare, Medicaid, any health care insurance company (“Payer”), and any other person or entity providing payment for any medical or health care services provided by Client or any applicable physician. Further, Client consents to and authorizes DAS to fulfill any reporting requirements that DAS, or any of its agents or employees may have under applicable law, or that are necessary or appropriate in DAS’ sole discretion, and Client agrees to hold DAS, and its agents, employees, officers, directors, shareholders, and assigns, harmless from any and all claims, actions, proceedings, losses, damages and expenses arising from or caused by such reporting. In the event Client directs DAS not to bill patient for patient’s portion of payments for medical services provided by Client, Client shall release and hold harmless DAS and its respective employees, officers, directors and shareholders for any losses or damages incurred as a result of such directive. Further, each party hereby agrees to defend indemnify and hold harmless the other party and its respective employees, officers, directors and shareholders from and against any and all claims, suits, injuries, demands, losses, costs, expenses, obligations, liabilities and damages, including without limitation, reasonable attorneys, paraprofessionals and law clerks fees throughout all stages of litigation including all appeals and all settlement, bankruptcy, and/or collection proceedings arising from such party acting reasonably and in good faith upon such directives from the other party. In accordance with applicable laws, regulations and Client’s Policy and Procedures, DAS has the discretion and authorization to negotiate the amount of the bill or payments for the medical services provided by Client to its patients, including but not limited to negotiating with patients, patients’ attorneys or representatives, insurance carriers, and/or third party payers. DAS shall have no liability for any failure to timely submit bills (including any denials of payments by insurance companies or third party payers) which result from Client’s failure to timely provide all necessary complete and accurate information and data to DAS. Notwithstanding anything contained herein to the contrary, DAS shall not be obligated to perform any duties that would result in any violation of federal, state or local laws or regulations.
Additional Limitation of Liability. DAS’ sole responsibility with respect to errors and/or omissions that occur is to correct such errors without additional cost to Client upon receipt of notice thereof. DAS shall have no liability to Client for any loss occasioned by Client’s conduct or the conduct of Client’s officers, agents, contractors or employees, including without limitation any loss arising out of incorrect or incomplete information. In no event shall DAS be liable to Client for lost profits or incidental or consequential damages or for any amount in excess of aggregate fees paid by Client to DAS within the sixty days prior to such claim, it being understood and agreed that Client hereby expressly waives any and all claims against DAS for any loss, cost, damages or liability that may be incurred by Client as a result of DAS’ acts or failures to act hereunder in excess of such amounts. DAS assumes no responsibility with respect to any unclaimed property, including unclaimed overpayments. Client acknowledges that Client is responsible for the accuracy of the fees and all other data provided to DAS for use in the provision of the billing and collection Services. DAS shall have no liability for the (a) inability of third parties or systems beyond the control of DAS to accurately process data, or (b) transmission to DAS of inaccurate data by Client, any hospital at which Client provides services, or any other third party. When accepting patient payments on behalf of Client, DAS will use reasonable commercial efforts to only accept such payments directly into a portal as directed by the Client, and Client expressly indemnifies DAS for any errors or omissions made in the course of such payment receipt activities. Client shall indemnify and hold harmless DAS from any liability whatsoever for any coding services (including entering, changing or deleting modifiers), and for DAS storage, retrieval, shipping and destruction of any Client records.