Patient Fees and Third-Party Billing Clause Samples

The 'Patient Fees and Third Party Billing' clause defines how patient charges are determined and how billing is managed when third parties, such as insurance companies, are involved. It typically outlines the responsibilities of the healthcare provider to collect fees directly from patients or to bill third parties on the patient's behalf, and may specify procedures for handling co-payments, deductibles, or denied claims. This clause ensures clarity in financial arrangements, helping to prevent disputes over payment responsibilities and streamlining the reimbursement process.
Patient Fees and Third-Party Billing. 6.1. Placer County residents receiving services as described in Section 1 shall be charged for such services in accordance with their ability to pay, but such charges shall not exceed the actual cost of providing such services. CONTRACTOR shall determine patient fees for Placer County residents based upon the ability to pay principle. CONTRACTOR shall establish policies and procedures for such fee assessment and collection including publication of current fee schedules for all billable services, which should be updated annually, covering all reimbursable costs. At no time is CONTRACTOR free to withhold services due to a Placer County patient’s inability to pay for all or a portion of services at the time they are required. After this Agreement’s expiration or cancellation, CONTRACTOR will continue to bill patients monthly to collect all revenue for services rendered to Placer County residents during the term of this Agreement. Patient fees collected from Placer County residents shall be budgeted and utilized to offset the costs charged against this Agreement.
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Patient Fees and Third-Party Billing. 1.2.1 Placer County residents receiving services as described in Exhibit A and A1 shall not be charged for such services by CONTRACTOR. CONTRACTOR shall not bill any third party for any services provided to Placer County residents under this contract. COUNTY will pay to CONTRACTOR as full payment for all services rendered pursuant to this Agreement in the amount set forth below in Section 2, Rates. The payment specified below in Section 2 shall be the only payment made to CONTRACTOR for services rendered pursuant to this Agreement. 1.2.2 CONTRACTOR shall not be responsible for billing or collecting from third party revenue sources including, but not limited to private insurance co-payments and Medi-Cal Share-of-Cost for Placer County residents receiving ancillary services (i.e. vision, dental, hearing aids, etc.) not included in Exhibit A or A1 and provided by other healthcare providers while under the care of CONTRACTOR.
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Patient Fees and Third-Party Billing. 1.2.1 CONTRACTOR shall make every reasonable effort to obtain any other third party or private reimbursement for which patients served hereunder may be eligible to receive for provision of mental health treatment services including the patient’s share of cost. Revenue collected will be deducted from total claim for expenses submitted to the COUNTY. When appropriate, COUNTY shall bill Medi-Cal and collect from the patient their share of cost for services provided pursuant to this Agreement. COUNTY and CONTRACTOR shall coordinate on the collection of share of cost from patient, based on the specifics of each case. Charges to insurance carriers shall be on the basis of CONTRACTOR’s usual and customary charges. 1.2.2 CONTRACTOR shall recover the value of covered services rendered to beneficiaries whenever the beneficiaries are covered for the same services, either fully or partially, under any other state or federal medical care program or under other contractual or legal entitlement including, but not limited to, a private group or indemnification program, but excluding instances of the tort liability of a third party or casualty liability insurance.
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Patient Fees and Third-Party Billing. 1.1. Any third party or private reimbursement revenue collected by Contractor will be deducted from total claim for expenses submitted to the COUNTY. When appropriate, COUNTY will bill Medi- Cal and collect from the patient their share of cost for services provided pursuant to this Agreement. COUNTY and CONTRACTOR shall coordinate on the collection of share of cost from patient, based on the specifics of each case. Charges to insurance carriers shall be on the basis of CONTRACTOR’s usual and customary charges. 1.2. CONTRACTOR shall recover the value of covered services rendered to beneficiaries whenever the beneficiaries are covered for the same services, either fully or partially, under any other state or federal medical care program or under other contractual or legal entitlement including, but not limited to, a private group or indemnification program, but excluding instances of the tort liability of a third party or casualty liability insurance. 1.3. Patient Fees: COUNTY will cooperate with CONTRACTOR and make every reasonable effort to obtain the signatures of the patient, conservator/guardian, or persons legally responsible for the patient on all forms necessary to maximize the collection of revenue. CONTRACTOR shall coordinate with COUNTY to determine if individuals are existing patients of COUNTY. Both parties shall share financial information obtained from those individuals determined to be pre-existing COUNTY patients.
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Patient Fees and Third-Party Billing. 1.5.1 At no time is CONTRACTOR free to withhold services due to a Placer County patient’s inability to pay for all or a portion of services at the time they are required. 1.5.2 CONTRACTOR shall be responsible for billing and collecting from all third party revenue sources for Placer County patients receiving services including, but not limited to, private insurance co-payments and Medi-Cal Share-of-Cost. CONTRACTOR is responsible for clearing and collecting the Share of Cost if any as required by the State of California. 1.5.3 CONTRACTOR shall recover the value of covered services rendered to Medi-Cal beneficiaries whenever the beneficiaries are covered for the same services, either fully or partially, under any other state or federal medical care program (if eligible) or under other contractual or legal entitlement including, but not limited to, a private group or indemnification program, but excluding instances of the tort liability of a third party or casualty liability insurance.
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Patient Fees and Third-Party Billing. 1.1. Any third party or private reimbursement revenue collected by Contractor will be deducted from total claim for expenses submitted to the COUNTY. When appropriate, COUNTY will bill Medi- Cal and collect from the patient their share of cost for services provided pursuant to this Agreement. COUNTY and CONTRACTOR shall coordinate on the collection of share of cost from patient, based on the specifics of each case. Charges to insurance carriers shall be on the basis of CONTRACTOR’S usual and customary charges. 1.2. CONTRACTOR shall recover the value of covered services rendered to beneficiaries whenever the beneficiaries are covered for the same services, either fully or partially, under any other state or federal medical care program or under other contractual or legal entitlement including, but not limited to, a private group or indemnification program, but excluding instances of the tort liability of a third party or casualty liability insurance.
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Patient Fees and Third-Party Billing. 1.5.1 At no time is CONTRACTOR free to withhold services due to a Placer County patient’s inability to pay for all or a portion of services at the time they are required. After this Agreement’s expiration or cancellation, 1.5.2 CONTRACTOR shall be responsible for billing and collecting from all third party revenue sources for Placer County patients receiving services including, but not limited to, private insurance co-payments and Medi-Cal Share-of-Cost. CONTRACTOR is responsible for clearing and collecting the Share of Cost if any as required by the State of California. 1.5.3 CONTRACTOR shall recover the value of covered services rendered to Medi-Cal beneficiaries whenever the beneficiaries are covered for the same services, either fully or partially, under any other state or federal medical care program (if eligible) or under other contractual or legal entitlement including, but not limited to, a private group or indemnification program, but excluding instances of the tort liability of a third party or casualty liability insurance.
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