This Services Agreement (“AGREEMENT”), effective as dated below (“Effective Date”), is entered into by and between CUSTOMER with an address as noted below and COMPANY with an address as noted below each a “Party” and collectively the “Parties”.
This AGREEMENT authorizes COMPANY to provide CUSTOMER with various services according to the Terms and Conditions of the AGREEMENT by and between the parties. Capitalized terms used herein shall have the meaning set forth in the Agreement.
COMPANY’s physician management services organization provides various services to healthcare customers. These services include:
- Practice growth / marketing
- Contact center (across various communication channels)
- Medication adherence management
- Remote Patient Monitoring
- Mobile diagnostics / imaging
- Billing and Collections
- Accounts Payables
- Overall Revenue Cycle Management
- Enrollment and Credentialing
- Clinical IT Services
To provide the aforementioned services, COMPANY approaches each engagement in one or more of the following ways:
- Work with PHI data made available to COMPANY staff via CUSTOMER HIPAA compliant healthcare CRM or EMR.
- Maintain and use HIPAA secure cloud contact center for inbound and outbound calls, SMS, faxes and other channels needed to support CUSTOMER engagement.
- IMPORTANT: WHATSAPP, IMESSAGE, GOOGLE MY BUSINESS, FACEBOOK and such social media channels require CUSTOMER to create their own endpoints, then transition the endpoints to COMPANY.
- Patient outreach to reappoint “No Show” patients
- Patient outreach to handle “patient intake” before patients arrive for their appointments (insurance card images, drivers license images, chief complaint, history of present illness, medication history, social history, medical history, surgical history, family history, allergies, tests etc)
- Patient outreach to proactively remind patients, thereby reducing “No shows”
- Patient outreach to reappoint “Cancelled” patients.
- Patient outreach to reactivate patients who have fallen out of care.
- Patient outreach to reduce referral leakage.
- Community outreach to gain new patients
- Patient referral request outreach to gain new patients
- Referred patient outreach to secure new patient appointments
- Patient outreach for balance due collections from patients. Accept patient balance payments over the phone using a PCI compliant payment website made available to our staff.
- Patient outreach for wellness visit campaigns
- Patient outreach for medication adherence escalation scenarios
- Patient outreach for ER discharges (within 24 hours)
- Physician outreach for securing physician referrals
- Maintain an IVR for inbound calls to CUSTOMER offices 8:30 AM – 5:30 PM in customer’s local timezone with breaks totalling an hour during the shift.
- Based on CUSTOMER needs, this is extended to 24 x 7 support as well (3 shifts per day, 7 days a week).
- Based on CUSTOMER approved staffing levels for the inbound call center, deliver the most feasible call center occupancy, call center service levels, average speed to answer, call abandon rates. COMPANY will calibrate their performance against industry standard (Erlang C ) calculations / forecasts.
- Maintain a fax channel for inbound pharmacy related faxes, handle pharmacy related calls and faxes based on clinical workflow rules (patient appointment within 6 months vs not)
- Handle all surgical coordination (prior authorizations, eligibility, payments, medical clearances, COVID clearances, transportation arrangements etc)
- Maintain a fax channel for Medical records requests from providers and third parties. Process all incoming requests for medical records after ensuring that we have documented medical record release consent forms signed by the patient. For certain medical request types where payment is expected by CUSTOMER, collaborate with CUSTOMER Billing Manager to send medical records upon instructions from CUSTOMER Billing manager.
- Outreach to patients seen each day, appoint them for the next visit. CUSTOMER frontdesk will be responsible for sharing the necessary spreadsheets daily for such appointments for patients.
- Accept billing related calls and advise patients on statement balances, explanation of benefits and outstanding balances.
- Check for patient portal activation status and activate patient portals to improve MIPS payments for CUSTOMER.
- Accept surgery related calls and patch them to the designated surgery coordinators.
EXPECTED SERVICE LEVELS
If we are provided the appropriate and required patient data to act upon, we anticipate that we will be able to provide the following service levels. While this is not guaranteed, we will attempt to deliver at these services levels (barring unforeseen circumstances).
- No show campaign = approximately 20 reappointed pts / staff / day
- Reactivation campaign = approximately 15 reappointed pts / staff / day
- Cancellations campaign = approximately 15 reappointed pts / staff / day
- Inbound calls handled / staff / day = approximately 60
- Outbound calls for referrals / staff / day = approximately 100
- Outbound calls for surgeries / staff / day = approximately 60
- Outbound calls for provider outreach / staff / day = approximately 40
- New patient data entry and pharmacy updates in EMR / day / staff = approximately 80
- Eligibility checks (manual process) / day / staff = approximately 75
- Payment posting / day / staff = approximately 200 CPTs
- Denials processing / day / staff = approximately 35 CPTs
- Credentialing / day / staff = approximately 20
- Prior authorizations of surgical procedures / day / staff = approximately 10
The following reports will be shared with CUSTOMER:
- “Weekly and monthly contact center activities” Report
- “Weekly and monthly Practice growth / marketing activities” Report
- “Weekly and monthly Practice growth / marketing activities” Report
- “Weekly and monthly Medication adherence” Report
- “Weekly and monthly RPM” Report
- “Weekly and monthly RCM performance” Report (overall)
- “Weekly and monthly Collections” Report (separate)
- “Weekly and monthly AP” Report (separate)
- “Weekly and monthly AR” Report (separate)
- “Weekly and monthly Credentialing” Report
- Barriers and improvement opportunities as identified by the team
ASSUMPTIONS & CUSTOMER RESPONSIBILITIES
This section describes the responsibilities of CUSTOMER to COMPANY with regard to this engagement. CUSTOMER’s project manager must have the authority to make project decisions and represent CUSTOMER in all matters related to this AGREEMENT. CUSTOMER’s project manager will provide a single consolidated response to any review, approval, change, or decision request.
CUSTOMER staff will actively participate in this engagement, and individuals with relevant domain, business, and/or technical expertise will be available as required. These participants are the acknowledged spokespersons for the areas they represent, and the COMPANY project team requires regular and timely access to them. If participants are unable to attend a scheduled meeting, then the CUSTOMER project manager becomes the final authority on all items of discussion.
CUSTOMER is responsible for, and assumes any risk associated with any problems resulting from the content, completeness, accuracy and consistency of any data, materials and information supplied by CUSTOMER.
Any change to the scope of work explicitly described in this Agreement, and any associated additional fees, must be mutually agreed in writing.
ADDITIONAL ENGAGEMENT SCOPE SPECIFICATIONS
The Services (including Deliverables) are subject to the following:
- Responsibility for staffing the engagement is owned by COMPANY.
- COMPANY will not be responsible for CUSTOMER delays and the consequent costs incurred.
- CUSTOMER is responsible for the performance of its employees and agents, including any contribution they make to the Services (including Deliverables), and for the accuracy and completeness of all data, information and materials provided to COMPANY.
- COMPANY’s performance is dependent upon timely decisions and approvals of CUSTOMER in connection with the Services and COMPANY is entitled to rely on all decisions and approvals of CUSTOMER.
- The Services and resulting Deliverables may include advice and recommendations, but CUSTOMER agrees that all decisions in connection with the implementation of such advice and recommendations will be the responsibility of, and made by, CUSTOMER.
- CUSTOMER acknowledges that its failure or delay to cooperate or furnish items as contemplated under this AGREEMENT or in performing its other responsibilities or obligations under this AGREEMENT, or a delay caused by any third party vendor providing services or products to CUSTOMER that impact the Services, will be considered CUSTOMER’s responsibility and an excusable delay or failure of COMPANY to the extent the Services are impeded or delayed.
- The fees for this project may be increased and the schedule may be extended, as appropriate and necessary, in the event of a change in engagement scope or a deviation in any assumption or dependency contained in this AGREEMENT, if any excusable delay or failure occurs or if CUSTOMER fails or is unable to comply with any of its responsibilities or other obligations under this SOW.
- COMPANY is not providing any third party software, tools or equipment or other third party products or materials to CUSTOMER.
- CUSTOMER is responsible to negotiate warranties for any third party software or other products it licenses or acquires.
- COMPANY is not responsible for any alteration or other modification made to a Deliverable by CUSTOMER or any third party (excluding any permitted subcontractors working for COMPANY) or for any work performed by CUSTOMER or its contractors in connection with this engagement.
- COMPANY may rely upon any standard operating procedures or practices of CUSTOMER and any direction or regulatory or other guidance provided by CUSTOMER.
- CUSTOMER is responsible for the identification and interpretation of, and ensuring compliance with, any laws, statutes, rules, regulations and standards applicable to its or its affiliates’ business or operations.
- The special pricing and/or incentives contained in this document in no way obligates COMPANY to offer similar pricing and/or incentives to CUSTOMER on additional or future engagements.
TERMS AND TERMINATION
Both parties are required to give a 2 month notice of termination of the contract in writing. Notification of termination via email by CUSTOMER or COMPANY contacts will be deemed sufficient.
|NO SHOWS RECOVERY CAMPAIGN|
|PATIENT REACTIVATION CAMPAIGN|
|CANCELLATIONS RECOVERY CAMPAIGN|
|REFERRAL LEAKAGE REDUCTION CAMPAIGN|
|COMMUNITY OUTREACH CAMPAIGN|
|PHYSICIAN REFERRAL OUTREACH CAMPAIGN|
|PATIENT REFERRALS OUTREACH CAMPAIGN|
|PATIENT INTAKE CAMPAIGNS|
|POST ER DISCHARGE CALL CAMPAIGNS|
|INBOUND PHARMACY CALLS|
|INBOUND BILLING CALLS|
|MEDICATION ADHERENCE PROGRAM|
|CREDENTIALING, PROVIDER ENROLLMENT, CAQH|
|PRIOR AUTHORIZATIONS, ELIGIBILITY|
|CODING, CHARGE POSTING, AR MANAGEMENT, PAYMENT POSTING|
FEES AND INVOICING
COMPANY will invoice CUSTOMER on a prepaid, monthly basis. All invoices are to be paid before the beginning of the month.
EFFECTIVE DATE: _______________________
|COMPANY: NISOS HEALTH|
ADDRESS: C-602, Citi Towers, Navi Mumbai 400706