Medical Billing Services Agreement

This Service Agreement ("Agreement") is entered into between:

Service Provider: Good Rack LLC, Medical Billing Services, a medical billing micro-agency ("Good Rack LLC," "we," "us," or "our").

Client: The solo behavioral health therapist, licensed counselor, psychologist, or behavioral health provider identified in the intake form or onboarding documentation ("Client," "you," or "your").

Together, the Service Provider and Client are referred to as the "Parties." This Agreement governs the professional relationship between the Parties and outlines the terms under which Good Rack LLC will provide medical billing support services.

Good Rack LLC agrees to provide the following medical billing support services as selected by the Client during onboarding:

• Claim Submission — Preparation and electronic submission of insurance claims on behalf of the Client.
• Payment Posting — Recording and reconciling insurance payments and Explanations of Benefits (EOBs).
• Denial Management — Reviewing, appealing, and resubmitting denied or rejected claims.
• Eligibility & Benefits Verification — Confirming patient insurance coverage and benefits prior to or at the time of service.
• Monthly Reporting — Providing regular reports summarizing billing activity, collections, and outstanding claims.
• Support & Communication — Responding to billing-related inquiries from the Client and coordinating with insurance payers as needed.

Any services not listed above, including but not limited to credentialing, legal advice, clinical documentation, or financial planning, are outside the scope of this Agreement unless separately agreed upon in writing. Optional add-on services may be added at any time and will be governed by this Agreement unless a separate addendum is executed.

To enable Good Rack LLC to perform services effectively, the Client agrees to:

• Provide accurate, complete, and timely patient and session information required for claim submission, including diagnosis codes, procedure codes, session dates, and provider credentials.
• Maintain an active and valid National Provider Identifier (NPI) and ensure all required credentialing is current with participating insurance payers.
• Notify Good Rack LLC promptly of any changes to insurance panel participation, provider information, or practice details.
• Grant Good Rack LLC authorized access to the Client's Electronic Health Record (EHR) system, practice management software, or payer portals as necessary to perform billing services.
• Review monthly reports and respond to any requests for additional information within a reasonable timeframe.
• Ensure that all patient records and documentation provided to Good Rack LLC are accurate and comply with applicable laws and regulations.
• Maintain appropriate professional liability insurance and any other insurance required by law or payer agreements.

The Client acknowledges that the accuracy and completeness of information provided directly affects the quality and timeliness of billing services. Good Rack LLC is not responsible for claim errors or delays resulting from incomplete, inaccurate, or late information provided by the Client.

Good Rack LLC agrees to:

• Submit claims accurately and in a timely manner based on the information provided by the Client.
• Follow up on unpaid, denied, or rejected claims within a reasonable timeframe.
• Maintain organized records of all billing activity performed on behalf of the Client.
• Communicate proactively about claim issues, payer responses, and any matters requiring the Client's attention.
• Handle all Client and patient information with strict confidentiality in accordance with HIPAA and applicable privacy laws.
• Provide monthly billing reports summarizing collections, outstanding balances, and claim status.
• Remain available during business hours (Monday–Friday, 9:00 AM–5:00 PM ET) for billing-related questions and support.

Good Rack LLC does not guarantee specific collection rates or reimbursement amounts, as these are determined by insurance payers and are outside our control. We commit to diligent, professional effort on behalf of every client.

Service fees are based on the Client's active caseload under the selected pricing plan:

• Starter Plan — $280/month (1–40 active clients)
• Growth Plan — $520/month (41–80 active clients)
• Full Support Plan — $720/month (81–120 active clients)

Invoicing: Invoices are issued on the 1st of each month for services rendered during that billing period.

Payment Due Date: Payment is due within 15 days of the invoice date.

Accepted Payment Methods: [To be specified — e.g., ACH bank transfer, check, or other agreed method].

Late Payments: Invoices not paid within 30 days of the due date may be subject to a late fee of [X]% per month on the outstanding balance. Good Rack LLC reserves the right to pause services on accounts with outstanding balances exceeding 30 days.

Price Changes: Good Rack LLC will provide at least 30 days' written notice before implementing any changes to service fees.

Add-On Services: Optional add-on services are billed separately at the rates listed at the time of selection and are due upon completion or as otherwise agreed.

Good Rack LLC follows a structured process for claim submission and follow-up:

1. Information Intake: The Client provides session notes, superbills, or session data through the agreed-upon method (EHR access, secure upload, or email).
2. Claim Preparation: Good Rack LLC reviews and prepares claims using the appropriate diagnosis codes (ICD-10), procedure codes (CPT), and billing modifiers.
3. Submission: Claims are submitted electronically to the relevant insurance payers within [X] business days of receiving complete session information.
4. Tracking: Good Rack LLC monitors claim status and follows up with payers on unpaid or pending claims.
5. Denial Management: Denied or rejected claims are reviewed, corrected where applicable, and resubmitted or appealed in a timely manner.
6. Reporting: The Client receives a monthly summary report detailing submitted claims, payments received, denials, and outstanding balances.

The Client is responsible for reviewing reports and flagging any discrepancies within 10 business days of receipt.

[PLACEHOLDER — This section should be reviewed and finalized by a qualified healthcare attorney before use.]

Good Rack LLC acknowledges that it may receive, access, or process Protected Health Information (PHI) as defined under HIPAA and its implementing regulations. Good Rack LLC agrees to use and disclose PHI only as permitted or required by applicable law; implement appropriate administrative, physical, and technical safeguards; report any known or suspected breach without unreasonable delay; and ensure that any subcontractors or agents who access PHI are bound by equivalent confidentiality obligations.

The Parties agree to execute a separate Business Associate Agreement (BAA) as required by HIPAA prior to the commencement of services. This Agreement does not substitute for a BAA. All non-PHI business information shared between the Parties shall also be treated as confidential and shall not be disclosed to third parties without prior written consent, except as required by law.

Term: This Agreement begins on the date both Parties have signed or electronically accepted it and continues on a month-to-month basis unless otherwise agreed in writing.

Termination by Either Party: Either Party may terminate this Agreement by providing at least 30 days' written notice to the other Party.

Termination for Cause: Either Party may terminate this Agreement immediately upon written notice if the other Party materially breaches any provision and fails to cure such breach within 10 business days of receiving written notice.

Effect of Termination: Upon termination, Good Rack LLC will complete any claims already in process and provide the Client with a final billing report. All outstanding invoices become due and payable immediately. The Client will retain ownership of all billing records and data related to their practice.

Transition Assistance: Good Rack LLC will cooperate in good faith to facilitate a smooth transition to a new billing provider, including providing access to billing records and outstanding claim information.

Business Hours: Monday–Friday, 9:00 AM–5:00 PM Eastern Time. Inquiries received outside business hours will be addressed on the next business day.

Response Times: Good Rack LLC will respond to routine inquiries within 1–2 business days. Urgent billing matters will be addressed as promptly as possible.

Primary Communication Channel: Email is the primary method of communication. The Client's designated email address and Good Rack LLC's contact email ([email protected]) will be used for all billing-related correspondence.

Monthly Check-Ins: Good Rack LLC may schedule optional monthly review calls to discuss billing performance, outstanding issues, and any changes to the Client's practice.

Client Updates: The Client agrees to notify Good Rack LLC promptly of any changes that may affect billing, including changes to insurance panels, provider information, EHR systems, or practice structure.

[PLACEHOLDER — This section should be reviewed and finalized by a qualified attorney before use.]

In the event of a dispute arising out of or relating to this Agreement, the Parties agree to first attempt to resolve the matter through good-faith negotiation. If the dispute cannot be resolved through negotiation within 30 days, the Parties agree to submit the matter to [mediation / binding arbitration / the courts of the State of New York] before pursuing any other legal remedy. Nothing in this section prevents either Party from seeking emergency injunctive or equitable relief from a court of competent jurisdiction where necessary to prevent irreparable harm.

[PLACEHOLDER — This section should be reviewed and finalized by a qualified attorney before use.]

Good Rack LLC provides medical billing support services and does not guarantee specific reimbursement outcomes, collection rates, or insurance approvals, as these are determined solely by insurance payers. To the fullest extent permitted by applicable law, Good Rack LLC's total liability to the Client for any claims arising out of or related to this Agreement shall not exceed the total fees paid by the Client to Good Rack LLC in the three (3) months immediately preceding the event giving rise to the claim. In no event shall Good Rack LLC be liable for any indirect, incidental, special, consequential, or punitive damages, including but not limited to loss of revenue, loss of profits, or loss of data, even if advised of the possibility of such damages.

By signing below (or by completing the electronic onboarding process), both Parties acknowledge that they have read, understood, and agree to be bound by the terms of this Service Agreement.

This Agreement constitutes the entire agreement between the Parties with respect to its subject matter and supersedes all prior discussions, representations, or agreements. Any modifications to this Agreement must be made in writing and signed by both Parties. If any provision of this Agreement is found to be unenforceable, the remaining provisions shall continue in full force and effect. This Agreement shall be governed by the laws of the State of New York, without regard to its conflict of law principles.