CaliMed Billing Terms and Conditions

Exclusive Representation: During the term of the agreement, CaliMed Billing acts as the primary agent for the Client’s billing and collection activities.

California Standards: We agree to perform all duties in accordance with federal laws and specific California regulations, such as the Knox-Keene Act.

Performance Targets: Our goal is to maintain a 98% clean claim rate and optimize your practice’s net collection ratio.

Data Provision: The Client is responsible for providing complete patient demographics and accurate encounter documentation.

Clinical Integrity: The Client retains ultimate responsibility for the medical necessity and clinical accuracy of the services documented in the EHR/EMR system.

Payer Contracts: The Client must provide current copies of all payer contracts, including those with Blue Shield of California, Kaiser Permanente, and Anthem.

Percentage-Based Fees: Fees are typically calculated as a percentage of monthly net collections, with rates often ranging between 2.49% and 9% depending on practice size and specialty.

Invoicing: CaliMed Billing will invoice the Client monthly for services rendered during the preceding month.

No Hidden Costs: Standard plans include all software integrations, real-time reporting, and dedicated account management with no hidden setup fees.

Business Associate Agreement (BAA): We execute a formal BAA with every Client to legally bind our team to HIPAA and HITECH Act standards.

Data Privacy: We utilize 256-bit encryption and secure EHR access to protect all Protected Health Information (PHI).

Confidentiality: Both parties agree to protect proprietary information, including proprietary coding strategies and internal practice data.

Duration: Most service agreements follow a standard initial term with options for renewal.

Termination for Convenience: Either party may terminate the agreement with a prior written notice period, typically 30 to 90 days.

Post-Termination Transition: Upon termination, CaliMed Billing will provide final reports and ensure a secure transition of all billing data.