Stop losing money on Medical Biller projects.
Send your first 3 contracts for free. Chasing aging accounts receivable without a formal agreement means you are essentially providing an interest-free loan to the medical practice. One HIPAA violation or a disputed commission on a large insurance payout can bankrupt your solo billing operation if your liability is not strictly capped.
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Statement of Work
Ref: 2026-001 • Standard Business Template
Overview
The Medical Biller shall perform all services as an independent contractor, adhering strictly to the Health Insurance Portability and Accountability Act (HIPAA) and all relevant state and federal billing regulations. The Biller is responsible for the timely submission of claims and the management of accounts receivable, but the Provider retains ultimate responsibility for the accuracy of clinical documentation and the determination of medical necessity for all services rendered. The Biller acts as a Business Associate and must enter into a separate Business Associate Agreement (BAA) to ensure the protection of all Protected Health Information (PHI) handled during the billing process.
Compensation shall be based on a mutually agreed-upon percentage of net collections or a flat monthly fee, as detailed in the payment schedule. This agreement protects the Biller against liability for claim denials resulting from inaccurate provider data while ensuring the Provider receives a transparent accounting of all financial transactions. In the event of contract termination, a tail coverage clause shall apply, granting the Biller continued commission on all claims submitted prior to the termination date that result in payment within ninety (90) days following the end of the service period.
Credentialing and Enrollment Gaps
Providers often assume billers will manage CAQH updates and payer enrollments for free. If a claim is denied because the provider's credentials expired, they may attempt to withhold your payment unless the contract explicitly excludes credentialing from your billing fee.
Software Access and Migration
If a practice switches EHR or PM systems mid-contract, you may lose access to historical data needed for appeals. Without a clause requiring the provider to maintain your software access, you cannot effectively work the old AR that you are still owed commission on.
Liability for Medical Necessity Denials
Clients may blame the biller for denials related to lack of medical necessity. Your contract must clarify that you are not responsible for the provider's failure to meet clinical documentation standards required by the payer's LCD or NCD guidelines.
What is a Medical Biller contract?
A medical biller contract template is a specialized service agreement that outlines the revenue cycle management duties, HIPAA compliance obligations, and payment terms between a billing specialist and a healthcare provider. It protects the biller by defining the scope of work, establishing liability limits for denied claims, and ensuring timely compensation for insurance follow-up.
Built from real freelance projects
This template is based on real-world scenarios across freelance projects where unclear scope, missing payment terms, and revision creep led to lost revenue. It is designed to protect your time, define expectations, and ensure you get paid.
Why Medical Billers need a clear contract
A medical billing contract is not just about getting paid. It is about defining where the provider's office work ends and your revenue cycle management begins. Medical billers face unique risks, such as being blamed for denials caused by poor clinical documentation or being expected to perform unpaid credentialing work. Without a specific contract, you might find yourself manually fixing demographic errors for hours without a 'clean claim' submission fee. A written agreement establishes whether you are paid on gross charges or net collections, which is a critical distinction that can cost you thousands in annual revenue. It also protects you during software migrations or when a provider suddenly decides to switch clearinghouses. Having these terms in writing ensures that you are compensated for the technical expertise required to navigate CPT codes and ICD-10 modifiers rather than being treated as an on-call administrative assistant.
Real-world scenario
A medical biller signs a client on a straight seven percent commission of net collections. The biller spends weeks cleaning up the provider's messy front-end data, only to find that the provider is consistently late in signing their charts. Because the claims cannot be submitted without a signed note, the biller's revenue stalls entirely. Two months later, the provider decides to close their private practice to join a large hospital group. Because the biller did not have a 'termination for convenience' clause that guaranteed payment for work in progress or a minimum monthly retainer, the biller loses hundreds of hours of labor. The provider stops responding to emails, and since the payments for the work performed will not hit the bank for another thirty days, the biller has no way to collect their commission on the final wave of revenue. The biller is left with software subscription costs and no income for two months of intense cleanup work.
🛡️ What this contract covers:
- ✓Phase 1: Practice Integration and Credentialing Audit, including insurance portal setup and verification of NPI and taxonomy data.
- ✓Phase 2: Full-Cycle Claims Management, encompassing coding review, electronic submission, and aggressive follow-up on all denied or underpaid claims.
- ✓Phase 3: Revenue Reconciliation and Financial Reporting, providing monthly summaries of net collections and the distribution of patient statements.
Best practices for Medical Billers
Define Net Collections Explicitly
Specify if your fee is calculated based on insurance payments only or if it includes patient co-pays, deductibles, and in-office cash payments.
Set a Minimum Monthly Retainer
Protect your time by charging a base monthly fee that applies if the provider's patient volume or collection total falls below a certain threshold.
Limit Appeal Rounds
Clearly state that your base fee includes one level of appeal. Second or third-level appeals and external reviews should be billed at a higher hourly rate.
Legal Disclaimer: MicroFreelanceHub is a software workflow tool, not a law firm. The templates and information provided on this website are for general informational purposes only and do not constitute legal advice.
Frequently Asked Questions
How is the billing fee calculated for recovered accounts?
Fees are calculated as a percentage of net collections received by the Provider, ensuring the Biller is only compensated for successfully processed payments.
What happens to the data if the contract is terminated?
Upon termination, the Biller will provide a final report and transition all pending claim data to the Provider, subject to a tail period for collections initiated during the contract.