Legal

Terms of Service

Please read these terms carefully before using our medical billing and revenue cycle management services.

Last Updated: March 3, 2026

These Terms of Service ("Terms") govern your access to and use of the services provided by Medfolio Billing Solutions ("Medfolio," "we," "us," or "our"). By engaging our services, you ("Client," "you," or "your") agree to be bound by these Terms.

If you do not agree to these Terms, please do not use our services. These Terms constitute a legally binding agreement between you and Medfolio.

1. Services Provided

Medfolio provides medical billing, revenue cycle management, provider credentialing, virtual assistant services, and related healthcare administrative services ("Services"). Specific services include:

  • Medical coding (ICD-10, CPT, HCPCS) and charge entry
  • Electronic and paper claim submission to insurance payers
  • Payment posting, denial management, and appeals
  • Accounts receivable management and patient billing
  • Provider credentialing and enrollment with insurance networks
  • Virtual assistant services for administrative support
  • Workers' compensation lien filing and collection
  • Web development and digital marketing for healthcare practices

The specific services provided to you will be outlined in your Service Agreement or Statement of Work. Services may be modified with mutual written consent.

2. Client Responsibilities

To enable us to provide Services effectively, you agree to:

  • Provide Accurate Information:

    Submit complete and accurate patient demographic information, insurance details, and clinical documentation

  • Timely Documentation:

    Provide encounter notes, superbills, and supporting documents within agreed timelines

  • System Access:

    Grant necessary access to your practice management system, EHR, and payer portals

  • Respond Promptly:

    Reply to requests for additional information or documentation within 3 business days

  • Maintain Compliance:

    Ensure all clinical documentation complies with applicable laws, regulations, and payer policies

  • Pay Invoices Timely:

    Submit payment for Services according to the agreed schedule and payment terms

Important: Failure to fulfill these responsibilities may result in delayed claim submissions, increased denials, or service interruptions. We are not liable for issues arising from incomplete or inaccurate information provided by you.

3. Fees and Payment Terms

Service Fees

Fees for Services are outlined in your Service Agreement or pricing quote and may be structured as:

  • Percentage of Collections: A percentage of amounts collected on submitted claims
  • Flat Monthly Fee: A fixed monthly retainer for services
  • Per-Transaction Fee: Fees based on claims, encounters, or credentialing applications
  • Hourly Rate: For consulting or project-based work
  • Contingency Fees: For workers' compensation lien collections (typically 10% of recovered amounts)

Payment Terms

  • Invoices are issued monthly and are due within 15 days of invoice date
  • Payment methods include ACH transfer, check, or credit card
  • Late payments incur a 1.5% monthly interest charge (18% annual)
  • Services may be suspended for accounts more than 30 days past due
  • You are responsible for all collection costs, including attorney fees, for delinquent accounts

Fee Adjustments

We reserve the right to adjust fees annually with 60 days' written notice. Fee changes will not apply retroactively to services already rendered.

4. Service Level Commitments

We strive to provide high-quality services and commit to the following standards:

  • Claim Submission: Claims submitted within 24-48 hours of receiving complete documentation
  • Denial Appeals: Initiated within 48 hours of denial notification (Professional/Enterprise plans)
  • Clean Claim Rate: Target of 98%+ first-pass acceptance
  • Response Time: Respond to client inquiries within 1 business day
  • Credentialing: Average completion within 60-90 days (subject to payer timelines)

These commitments are contingent upon receiving complete and accurate information from you. Delays caused by incomplete documentation, payer processing times, or third-party factors are outside our control.

5. Term and Termination

Initial Term

Unless otherwise specified in your Service Agreement, services begin upon signing and continue on a month-to-month basis.

Termination for Convenience

Either party may terminate this agreement with 30 days' written notice. Upon termination:

  • • You remain responsible for payment of all services rendered through the termination date
  • • We will provide transition support for 30 days to facilitate handoff to a new billing company
  • • All pending claims will be submitted unless you direct otherwise
  • • Final invoices will be issued for outstanding collections or services

Termination for Cause

Either party may terminate immediately for cause, including:

  • • Material breach of these Terms that remains uncured after 15 days' written notice
  • • Non-payment of fees for more than 30 days
  • • Violation of HIPAA or other applicable laws
  • • Bankruptcy, insolvency, or cessation of business operations

Post-Termination Collections: If services end, we retain the right to collect on claims submitted prior to termination. You will owe fees on those collections per your agreed fee structure.

6. Confidentiality and HIPAA

Both parties agree to maintain strict confidentiality of all proprietary and sensitive information exchanged during the course of providing Services.

Business Associate Agreement

As a business associate under HIPAA, we execute a separate Business Associate Agreement (BAA) with you outlining our obligations regarding protected health information (PHI). The BAA is incorporated by reference into these Terms.

PHI Usage

We will only use and disclose PHI as necessary to perform Services, comply with legal obligations, or as permitted under the BAA and HIPAA regulations.

7. Limitation of Liability

IMPORTANT LEGAL NOTICE: Please read this section carefully as it limits our liability.

To the maximum extent permitted by law, Medfolio's total liability for any claims arising from or related to Services shall not exceed the total fees paid by you to Medfolio in the 12 months preceding the claim.

We are not liable for:

  • Indirect, incidental, consequential, or punitive damages
  • Lost profits, revenue, or business opportunities
  • Claim denials resulting from incomplete or inaccurate documentation provided by you
  • Delays caused by insurance payers, government agencies, or third parties
  • Changes in payer policies, coding guidelines, or regulations
  • System outages, data breaches, or technical failures beyond our reasonable control
  • Medical malpractice or professional liability claims arising from your clinical services

8. Warranties and Disclaimers

Our Warranties

We warrant that Services will be performed:

  • • In a professional and workmanlike manner by qualified personnel
  • • In compliance with applicable laws, including HIPAA
  • • Using industry-standard practices for medical billing and coding

Disclaimer

EXCEPT AS EXPRESSLY PROVIDED IN THESE TERMS, SERVICES ARE PROVIDED "AS IS" WITHOUT WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO:

  • • Implied warranties of merchantability or fitness for a particular purpose
  • • Guarantees of specific collection amounts or clean claim rates
  • • Warranties regarding credentialing approval or timelines
  • • Guarantees that claims will not be audited, denied, or subject to recoupment

We provide professional billing services but cannot control payer decisions, audit outcomes, or reimbursement rates.

9. Indemnification

You agree to indemnify, defend, and hold harmless Medfolio and its employees, contractors, and agents from any claims, losses, damages, liabilities, and expenses (including reasonable attorney fees) arising from:

  • Your breach of these Terms or the BAA
  • Inaccurate or incomplete information provided by you
  • Your violation of applicable laws or regulations
  • Medical malpractice or professional liability claims related to clinical care
  • Payer audits, recoupments, or investigations related to your billing practices

10. Dispute Resolution

Informal Resolution

In the event of any dispute, both parties agree to first attempt informal resolution through good-faith negotiations for 30 days before pursuing formal proceedings.

Binding Arbitration

If informal resolution fails, any dispute shall be resolved through binding arbitration administered by the American Arbitration Association (AAA) under its Commercial Arbitration Rules. The arbitration shall be conducted in New York, NY, and judgment on the award may be entered in any court of competent jurisdiction.

Exceptions

Either party may seek injunctive relief in court for breaches related to confidentiality, intellectual property, or HIPAA violations without first pursuing arbitration.

11. Governing Law

These Terms shall be governed by and construed in accordance with the laws of the State of New York, without regard to its conflict of law provisions. You consent to the exclusive jurisdiction of state and federal courts located in New York for any disputes not subject to arbitration.

12. General Provisions

Entire Agreement

These Terms, together with any Service Agreement and BAA, constitute the entire agreement between the parties and supersede all prior agreements, understandings, and communications.

Amendments

We may update these Terms from time to time. Material changes will be communicated with 30 days' notice. Continued use of Services after changes take effect constitutes acceptance.

Assignment

You may not assign or transfer your rights under these Terms without our prior written consent. We may assign our rights to any successor entity in connection with a merger, acquisition, or sale of assets.

Severability

If any provision of these Terms is found to be invalid or unenforceable, the remaining provisions will remain in full force and effect.

Waiver

Failure to enforce any provision of these Terms does not constitute a waiver of that provision or any other provision.

Force Majeure

Neither party shall be liable for failure to perform due to causes beyond reasonable control, including natural disasters, pandemics, government actions, or internet/utility failures.

13. Questions About These Terms

If you have questions about these Terms of Service, please contact us:

Medfolio Billing Solutions

By using our services, you acknowledge that you have read, understood, and agree to be bound by these Terms of Service.