An all-in-one advanced EHR that keeps visits moving. Book a demo.
Download PDF
This Edvak RCM Services Attachment ("RCM Attachment") applies only if Billing (RCM) Services are selected on Customer's Order Form. When it applies, it is incorporated into and forms part of the Agreement between Edvak Technologies Inc. ("Edvak") and Customer. Capitalized terms not defined in this RCM Attachment have the meanings given in the Edvak Master Subscription Agreement ("MSA"), the Edvak Business Associate Agreement ("BAA"), or the Order Form.
1.1 Scope. Edvak will provide the following revenue cycle management services ("RCM Services") for patient encounters documented in the Edvak platform during the RCM Term: (a) claim preparation, scrubbing, and submission to payers through Edvak's clearinghouse; (b) monitoring and correction of claim rejections and resubmission; (c) review of claim denials, correction and resubmission, and preparation of appeals at Customer's direction; (d) posting of payer remittances (including ERA and EOB) and payment reconciliation within the platform; (e) identification of patient responsibility and generation of patient statements through the platform; and (f) standard RCM performance reporting made available in the platform.
1.2 Exclusions. Unless separately stated on an Order Form, RCM Services do not include: coding determinations or coding audits (Section 2(b)); provider credentialing or payer enrollment; payer contracting or fee schedule negotiation; collection agency engagement, collections litigation, or legal services of any kind; and services for encounters not documented in the Edvak platform.
1.3 Standard of Performance. Edvak will perform the RCM Services in a timely and professional manner consistent with generally accepted industry standards for comparable services.
Customer will: (a) provide complete, accurate, and timely clinical documentation and charge information for each encounter; (b) retain final authority and responsibility for all coding and billing decisions, including selection of procedure and diagnosis codes, and for the accuracy of all claims submitted in Customer's name; (c) obtain and maintain active payer enrollments (including EDI, ERA, and EFT enrollments) and provider credentialing; (d) provide information, approvals, and access reasonably needed for Edvak to perform the RCM Services; (e) respond within a reasonable time to Edvak's requests relating to rejections, denials, or missing documentation; and (f) comply with its payer contracts and with Laws applicable to Customer's practice and billing. Edvak's performance is excused to the extent an obligation cannot be performed due to Customer's failure to meet the responsibilities in this Section 2.
Customer authorizes Edvak and its personnel to prepare and submit claims, exchange information with payers and clearinghouses, respond to routine payer correspondence, and post remittances, in each case on Customer's behalf and solely as necessary to perform the RCM Services. This authorization makes Edvak Customer's limited agent for these administrative purposes only. Edvak will not exercise independent discretion over clinical judgments, coding selections, or decisions to write off, adjust, or pursue any balance; those decisions remain with Customer.
4.1 Fee. Customer will pay the RCM Fee stated on the Order Form, calculated as the stated percentage of Collections for each calendar month and invoiced monthly in arrears.
4.2 Collections. "Collections" means amounts actually received by or on behalf of Customer during a calendar month from payers and patients with respect to claims and patient balances processed through the RCM Services, net of refunds issued and payer recoupments applied during that month. Collections exclude amounts unrelated to the RCM Services.
4.3 Payment. RCM Fees are invoiced and payable in accordance with the payment terms of the Order Form and the MSA.
4.4 Trailing Collections. For claims submitted during the RCM Term, the RCM Fee continues to apply to related Collections received during the 90 days following the end of the RCM Term.
5.1 Disclosure. Edvak may use qualified personnel located outside the United States (currently in India and the Philippines) to perform the RCM Services.
5.2 Controls. All Protected Health Information remains hosted in Edvak's United States cloud environment (currently Amazon Web Services, U.S. East region). Personnel located outside the United States access the platform only through controlled sessions that are limited to viewing and in-platform workflow actions; technical controls are designed to prevent bulk export, download, printing, and local storage of Protected Health Information; access is role-based, logged, and limited to the minimum necessary to perform the RCM Services; and such personnel are bound by written confidentiality obligations and receive HIPAA training. No Protected Health Information is stored on servers or devices located outside the United States.
5.3 Payer and Program Restrictions. Certain payers or government programs may restrict or prohibit access to claims data or Protected Health Information from outside the United States. Customer is responsible for identifying any such restriction that applies to Customer's payer mix and notifying Edvak in writing. Upon notice, the parties will cooperate in good faith to implement a compliant workflow for the affected payers, including onshore-only handling where required.
5.4 BAA Governs. All access to and handling of Protected Health Information under this RCM Attachment is governed by the BAA.
6.1 Regulatory Compliance. Each party will comply with the Laws applicable to its role in the RCM Services, including HIPAA. Customer remains responsible for compliance with Laws and payer requirements governing the billing of health care services rendered by Customer and its providers.
6.2 No Guarantee of Outcomes. Edvak does not guarantee payment of any claim, reimbursement amounts or rates, collection results, denial or appeal outcomes, or the conduct of any payer.
6.3 No Legal, Coding, or Compliance Advice. The RCM Services are administrative in nature. Edvak does not provide legal, medical coding, or regulatory compliance advice, and no element of the RCM Services or related reporting constitutes such advice.
6.4 Records. Each party will maintain records relating to the RCM Services as required by applicable Law.
7.1 RCM Term. The "RCM Term" begins on the Order Date (or a different start date, if one is stated on the Order Form) and continues for as long as the underlying subscription remains in effect, unless earlier terminated under this Section 7.
7.2 Termination for Convenience. Either party may terminate the RCM Services — without terminating the underlying subscription — for any or no reason upon 60 days' written notice to the other party.
7.3 Wind-Down and Transition. Following notice of termination, Edvak will continue to process claims submitted before the effective date of termination through the end of the RCM Term and, at Customer's election, will reasonably cooperate to transfer work in progress to Customer or its designee. Section 4.4 (Trailing Collections) applies to Collections received after the RCM Term ends.
7.4 Survival. Sections 4 (RCM Fees, with respect to amounts accrued), 5.4 (BAA Governs), 6 (Compliance; No Guarantees), 7.3 (Wind-Down and Transition), 7.4 (Survival), and 8 (Order of Precedence) survive termination or expiration of the RCM Services.
With respect to the RCM Services, this RCM Attachment controls over the MSA. The BAA controls over this RCM Attachment with respect to Protected Health Information. The Order Form controls over this RCM Attachment.
