HomeMy WebLinkAboutC-2327CMRE FINANCIALS ERVICES, INC.
CMRE Financial Services, Inc
Collection Services Agreement
SERVICE AND SOLUTIONS DESIGNED TO MEET THE UNIQUE
REQUIREMENTS OF THE HEALTHCARE INDUSTRY
75 E. Imperial Hwy., Suite 200 • Brea, CA 92821 • (714) 528 -3200 • Fax: (714) 528 -5863 • (800) 783 -9118
Web Page: http: / /www.cmrefsi.com
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CMRE Financial Services, Inc.: Collection Agreement.
This agreement is made and entered into between of Arcadia (CLIENT) and CMRE Financial Services Inc.
(AGENCY) to be effective the _ / day of 007, or upon receipt of accounts whichever shall first occur.
Subject to each party's right of termination as set forth below, this Agreement shall be for a two (2) year term from effective date.
Agreement shall automatically renew each year on the anniversary of above indicated effective date.
A. AGENCY agrees to provide collection services as outlined in the Collection Services Overview.
B. Scheduled Services. AGENCY shall provide Services at times mutually agreeable between both parties.
C. Business Reports. Upon request, AGENCY shall prepare and submit to CLIENT, in such detail as CLIENT reasonably may
require, business reports relating to the Services.
D. Medical Records. In accordance with Applicable Laws, AGENCY shall maintain the confidentiality of all patient - related
medical records information. CLIENT retains exclusive rights to the ownership of and control of all medical records. -
E. AGENCY'acknowledges agency capacity and at all times promises to represent CLIENT in the best possible light. All
documentation is the sole property of CLIENT. AGENCY will cancel accounts as specifically requested by CLIENT. Said
request may be performed by phone or written communication. -
F. AGENCY's Status. AGENCY shall act at all times under this Agreement as an independent contractor. The parties hereto
agree that CLIENT shall not have and shall not exercise any control or direction over the manner or methods by which
AGENCY provides the Services set forth herein. However, AGENCY agrees to perform the Services at all times in
accordance with Applicable Laws and currently approved methods and standards of practice in the profession and shall act
at all times in accordance with applicable ethical and professional standards. AGENCY shall have no claim under this
Agreement or otherwise for vacation or sick leave, retirement benefits, Social Security, workers' compensation, disability or
unemployment insurance benefits, or employee benefits of any kind.. AGENCY shall be solely responsible for the payment
of all applicable federal, state, and local income or other taxes (including, but not limited to, federal social security tax and
federal and state unemployment taxes) on the compensation received under this Agreement. The sole interest and obligation
of CLIENT is to assure that the Services will be performed in a competent, efficient, and satisfactory manner. -
G. Indemnity.
L CLIENT covenants and agrees to indemnify and hold harmless AGENCY from and against any and all losses,
damages, expenses, or other - liabilities, including reasonable attorneys' fees incurred as a result of the negligent acts,
intentional acts, breach of this Agreement or omissions of CLIENT's agents, servants, or employees.
2. AGENCY covenants and agrees to indemnify and hold harmless CLIENT from and against any and all losses,
damages, expenses, or other liabilities, including reasonable attorneys' fees incurred as a result of the negligent acts,
intentional acts, breach of this Agreement or omissions of AGENCY's agents, servants, or employees.
H. Financial Obligation. AGENCY shall not incur nor shall AGENCY have authority to incur any financial obligation on
behalf of CLIENT without the prior approval of CLIENT.
I. Notices. Notices or communications required or permitted to be given under this Agreement shall be in writing and given to
the respective parties either by personal delivery or by certified mail, return receipt requested, addressed as follows, unless a
party shall notify the other in writing of a change of address:
AGENCY:
CLIENT:
CMREFinancial Services Inc.
3075Im er[a] Hwy Suite 200 City Of Arcadia
Brea. CA 92821 240 W Huntin ton Drive
Arcadia Ca 91007
Notices given pursuant to this Paragraph shall be deemed to have been given upon delivery if personal delivery, and if
mailed, two (2) days after the date of mailing.
J. Entire Agreement: This Agreement supersedes all previous agreements and representations, whether oral or written,
between the parties and constitutes the entire Agreement between the parties regarding the subject matter hereof.
K. Binding Arbitration. Both parties agree to binding arbitration for unresolved disputes. The rules of the American
Arbitration Association will prevail with each party equally sharing in the cost. Each party will have full discovery rights.
The prevailing party will recover from the other party all costs, fees, losses, including attorneys' fees and damages.
L. Provisions Held Invalid. If any one or more of the provisions contained in this Agreement shall for any reason be held by a
court of competent jurisdiction to be invalid, illegal, or unenforceable in any respect, such invalidity, illegality, or
unenforceability shall not affect any other provision hereof, and this Agreement shall be construed and interpreted as if such
provision had never been contained herein.
M. Insurance, AGENCY maintains and agrees to continue to maintain errors and omissions liability and professional liability
insurance.
N. Confidentiality. AGENCY shall maintain the confidentiality of all patient - related billing and medical records information.
0. Termination. Notwithstanding anything herein to the contrary, this agreement may be terminated at any time as follows:
1. Whenever CLIENT and AGENCY shall mutually agree in writing; or
2. Without cause by either party upon at least thirty- (30) days prior written notice to the other party in which case the
agreement shall terminate on the future date specified in such notice.
P. Health Information- Portability and Accountability Act ( HIPAA). This Agreement is entered into by AGENCY as a
business associate and CLIENT pursuant to the requirements of HIP" and nothing herein shall be a basis for determining
or construing AGENCY as a covered entity under HIPAA. As such, CLIENT shall implement appropriate safeguards to
protect against unauthorized disclosure of protected health information (PHI) and protect confidential patient information.
termination of this agreement for any reason
AGENCY will implement regulations and restrictions to protect against unauthorizdd disclosure of PHI, but not be limited
to the following which:
1. Require AGENCY to become knowledgeable about HIPAA regulations and the security features available within their
systems;
2. Prohibit AGENCY from further use or disclosure beyond the purpose stated in the contract;
3. Prohibit AGENCY from any use or disclosure that would violate HIPAA regulations.
4. Require AGENCY to maintain safeguards to ensure data is used and disclosed as specified by the contract;
5. Require AGENCY to report any misuse or unauthorized disclosure to the information security officer or other
specified individual within CLIENT organization;
6. Require AGENCY to have all subcontractors, or any agents to whom it provides PHI agree to these same restrictions;
7. Establish a procedure for CLIENT to have access to protect information in AGENCY's possession when it has been
materially altered by the AGENCY;
8. Require AGENCY to provide access to patients who request their information.
9. Require AGENCY to make its internal practices, books, and records related to PHI available to U.S. Department of
Health and Human Service (DHHS) or its agents for enforcement of HIPAA regulations;
10. Require AGENCY to incorporate a patient's amendment or correction, if requested:
11. Require AGENCY at termination of contract to return or destroy all protected information as determined in the
discretion of Client
12. Provide that individuals who are the subject of PHI are intended to be third -party beneficiaries of this contract;
13. Require Agencv to make available vut f r nmPnr..,e.,r .,.,,,
14.
15.
Q. CLIENT agrees to comply with and otherwise abide by the following conditions in the assignment of accounts receivable:
I. CLIENT will not knowingly place for collection any account that by state or federal law is precluded or barred from
collection at the time of placement. CLIENT will ascertain that all charges assigned will be legally proper and just
debts that federal and state regulations have been met by the CLIENT.
2. CLIENT understands that AGENCY must comply with the Fair Debt Collections Practices Act ( FDCPA) and Fair
Credit Reporting Act (FCRA) and in doing so must rely in part on the representations of the CLIENT as to the amount
of the account and any interest, service fees or charges added by the Client to the account. CLIENT certifies that
when interest is added in excess of normal legal interest or service fees are added that it has a contract with patient -
debtor that it will provide to AGENCY upon request. Should CLIENT fail to maintain or provide the said agreement,
the CLIENT shall hold AGENCY harmless for all costs associated with defending a FDCPA and /or FCRA claim,
including attorney fees, resulting from such breach.
3. CLIENT will mark on its system so as to identify all accounts assigned to AGENCY for collections.
4. CLIENT will promptly report any and all payments received on assigned accounts.
5. CLIENT will promptly notify AGENCY of any notices of Bankruptcy and will further provide information regarding
any workers' compensation claim. CLIENT will not place any account for collection that is reported to be in
bankruptcy.
6. CLIENT grants and conveys to AGENCY the right of endorsement in clearing drafts and checks for payment.
7. CLIENT will inform its staff on all working conditions of collection services agreement with AGENCY.
R. Contingency Fees: Contingency fees are based upon the actual amounts collected by AGENCY and direct payments
reported to AGENCY by CLIENT. AGENCY is responsible for all collection costs unless AGENCY and CLIENT agree
otherwise.
h '',Sery ce r 3 Conttd`enc Fee
g._ Y
Soft -core Collection Services N/A
Bad DebtCollect�ans iis' ., , l i` 30 ,f i
Sad Debt Collections — Legal with suit filed 40%
IN WITNESS WHEREOF, the undersigned 'k. dersigned haverrexecutted this agreement as of the date first above written.
CLIENT: 1 1 n !lY .L i �. I.r
AGENCY:
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Signature &
C
eone'ue
_,,. Jr,x VICES AUTHORIZATION
Provider:
Address:
City, State & Zip:
The undersigned, an authorized agent of the provider as indicated above, hereby certifies that CMRE
Financial Services, Inc. (and its wholly owned subsidiaries and divisions, located at 3075 E. Birch
Imperial Hwy. Suite 200, Brea CA 92821) is an authorized agent providing billing (primary claim
submission and/or resubmission) and complete collection services on behalf of the above referenced
provider.
(Name)
(Signature)
(Date)