Terms of Service

1. Acceptance of Terms

By accessing this website, contacting us for services, or entering into a service agreement with Healix RCM, you acknowledge that you have read, understood, and agree to be bound by these Terms and our Privacy Policy.

These Terms constitute a legally binding agreement between you (the "Client," "you," or "your") and Healix RCM. If you are entering into this agreement on behalf of a healthcare practice, organization, or entity, you represent and warrant that you have the authority to bind that entity to these Terms.

2. Service Description

Healix RCM provides medical billing, revenue cycle management, and related healthcare administrative services, including but not limited to:

• Medical Billing Services: Claims submission, follow-up, and payment posting
• Revenue Cycle Management: End-to-end revenue cycle optimization and management
• Claims Processing: Claims editing, scrubbing, submission, and tracking
• Denial Management: Denial analysis, appeals, and resolution
• Prior Authorization: Authorization requests and management
• Provider Credentialing: Credentialing and enrollment services
• Patient Billing: Patient statement generation and payment processing
• Reporting and Analytics: Financial reporting and performance analytics

Specific services provided to each Client will be outlined in individual service agreements or statements of work. We reserve the right to modify, suspend, or discontinue any service with reasonable notice to affected Clients.

Service Availability

We strive to provide uninterrupted service, but we do not guarantee that our services will be available at all times. Services may be temporarily unavailable due to maintenance, technical issues, or circumstances beyond our control. We will provide reasonable notice of planned maintenance when possible.

3. User Responsibilities

As a Client of Healix RCM, you agree to:

3.1 Provide Accurate Information

• Provide complete, accurate, and timely information necessary for billing services
• Maintain accurate patient demographics, insurance information, and clinical documentation
• Promptly notify us of any changes to your practice information, providers, or services
• Ensure all clinical documentation supports the services billed

3.2 Compliance with Laws and Regulations

• Comply with all applicable federal and state healthcare laws and regulations
• Maintain all required licenses, certifications, and credentials
• Ensure medical services are properly documented and medically necessary
• Follow HIPAA Privacy and Security Rules for all PHI
• Report any suspected fraud, abuse, or compliance violations

3.3 System Access and Security

• Maintain the confidentiality of login credentials and access information
• Promptly notify us of any unauthorized access or security breaches
• Use our systems and services only for lawful purposes
• Not attempt to circumvent security measures or access unauthorized data
• Implement appropriate safeguards to protect PHI in your possession

3.4 Cooperation and Communication

• Respond promptly to requests for information or clarification
• Provide timely access to necessary systems, records, and personnel
• Review reports and statements in a timely manner
• Notify us of any billing errors or concerns within 30 days

4. Payment Terms

4.1 Service Fees

Our fees for services are outlined in individual service agreements and may be structured as:

• Percentage of Collections: A percentage of amounts collected on your behalf
• Fixed Monthly Fee: A flat monthly fee regardless of collections
• Hybrid Model: A combination of percentage and fixed fees
• Project-Based: Fixed fees for specific projects (e.g., credentialing)

4.2 Payment Processing

For percentage-based fees, we may:

• Deduct our fees from collections before remitting payments to you, OR
• Invoice you separately for services rendered

The specific payment method will be defined in your service agreement.

4.3 Payment Timing

• Invoices are typically issued monthly
• Payment is due within 30 days of invoice date unless otherwise specified
• Late payments may incur interest charges at the rate of 1.5% per month (18% annually) or the maximum rate permitted by law, whichever is lower
• We reserve the right to suspend services for accounts more than 60 days past due

4.4 Setup and Implementation Fees

Initial setup and implementation fees (if applicable) are typically due before services commence and are non-refundable once implementation begins.

4.5 Fee Adjustments

We reserve the right to adjust fees annually with 60 days' written notice. Fee increases will not exceed 10% per year unless mutually agreed upon.

5. Intellectual Property

5.1 Healix RCM Property

All content, features, and functionality of our website and services, including but not limited to:

• Text, graphics, logos, icons, and images
• Software, tools, and technology platforms
• Proprietary processes and methodologies
• Templates, reports, and analytical tools
• Trademarks, service marks, and trade names

are owned by or licensed to Healix RCM and are protected by United States and international copyright, trademark, patent, trade secret, and other intellectual property laws.

5.2 Limited License

We grant you a limited, non-exclusive, non-transferable license to access and use our services solely for your internal business purposes in accordance with these Terms. This license does not include the right to:

• Modify, copy, distribute, or create derivative works
• Reverse engineer, decompile, or disassemble our software or systems
• License, sell, rent, lease, or otherwise transfer our services to third parties
• Remove or alter any proprietary notices or labels

5.3 Client Data

You retain all ownership rights to your patient data, clinical documentation, and other information you provide to us. We will use your data only to provide services and as permitted by our Business Associate Agreement and Privacy Policy.

5.4 Aggregated Data

We may create anonymized, de-identified, and aggregated data from Client information for internal purposes such as benchmarking, quality improvement, and industry analysis. This aggregated data will not contain any PHI or personally identifiable information.

6. Limitation of Liability

6.1 Disclaimer of Warranties

OUR SERVICES ARE PROVIDED "AS IS" AND "AS AVAILABLE" WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, OR COURSE OF PERFORMANCE.

We do not warrant that:

• Services will be uninterrupted, timely, secure, or error-free
• Results obtained from services will be accurate or reliable
• Any errors in our technology or services will be corrected
• All claims will be paid by insurance companies or patients

6.2 Limitation of Damages

TO THE MAXIMUM EXTENT PERMITTED BY LAW, IN NO EVENT SHALL HEALIX RCM, ITS OFFICERS, DIRECTORS, EMPLOYEES, OR AGENTS BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES, INCLUDING BUT NOT LIMITED TO:

• Loss of profits, revenue, or business opportunities
• Loss of data or information
• Business interruption
• Loss of goodwill or reputation
• Cost of substitute services

WHETHER BASED ON WARRANTY, CONTRACT, TORT (INCLUDING NEGLIGENCE), OR ANY OTHER LEGAL THEORY, EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

6.3 Cap on Liability

TO THE MAXIMUM EXTENT PERMITTED BY LAW, OUR TOTAL AGGREGATE LIABILITY FOR ALL CLAIMS ARISING OUT OF OR RELATING TO THESE TERMS OR OUR SERVICES SHALL NOT EXCEED THE TOTAL AMOUNT OF FEES PAID BY YOU TO HEALIX RCM DURING THE TWELVE (12) MONTHS IMMEDIATELY PRECEDING THE EVENT GIVING RISE TO THE CLAIM.

6.4 Exceptions

Some jurisdictions do not allow the limitation or exclusion of liability for incidental or consequential damages. In such jurisdictions, our liability will be limited to the greatest extent permitted by law.

Nothing in these Terms shall limit or exclude our liability for:

• Death or personal injury caused by our negligence
• Fraud or fraudulent misrepresentation
• Gross negligence or willful misconduct
• Any other liability that cannot be excluded by law

7. HIPAA Business Associate Agreement

7.1 BAA Requirements

The Business Associate Agreement will:

• Define the permitted uses and disclosures of PHI
• Require us to implement appropriate safeguards for PHI
• Require us to report security incidents and breaches
• Establish procedures for PHI access, amendment, and accounting of disclosures
• Address PHI return or destruction upon termination
• Limit our ability to use PHI for purposes other than providing services

7.2 Relationship to These Terms

The BAA supplements these Terms of Service. In the event of any conflict between these Terms and the BAA regarding the use or disclosure of PHI, the BAA shall control.

7.3 HIPAA Compliance

As a Business Associate, we will:

• Comply with applicable provisions of the HIPAA Privacy, Security, and Breach Notification Rules
• Implement administrative, physical, and technical safeguards to protect PHI
• Train our workforce on HIPAA requirements
• Maintain appropriate policies and procedures for PHI protection
• Cooperate with your HIPAA compliance efforts

You, as the Covered Entity, remain ultimately responsible for compliance with all HIPAA requirements, including ensuring the accuracy and completeness of PHI, maintaining patient authorizations, and responding to patient requests regarding their PHI.

8. Termination

8.1 Termination by Client

You may terminate your service agreement by providing written notice as specified in your service agreement, typically:

• Standard Termination: 90 days' written notice
• For Cause: Immediate termination if we materially breach these Terms and fail to cure within 30 days

8.2 Termination by Healix RCM

We may terminate your service agreement:

• For Non-Payment: If your account is more than 60 days past due
• For Breach: If you materially breach these Terms and fail to cure within 30 days
• For Cause: Immediately if you engage in fraud, illegal activity, or misrepresentation
• Without Cause: With 90 days' written notice

8.3 Effect of Termination

Upon termination:

• You remain responsible for all fees incurred up to the termination date
• We will cease providing services as of the termination date
• We will provide a final accounting and remit any outstanding collections (less our fees)
• We will cooperate with you or your new billing provider to ensure smooth transition
• All licenses granted under these Terms will immediately terminate

8.4 Data Return and Destruction

Within 30 days of termination, we will:

• Return or destroy all PHI and Client data in our possession (as directed by you)
• Certify in writing that PHI has been returned or destroyed
• If return or destruction is not feasible, we will extend protections and limit further uses as required by HIPAA

8.5 Survival

The following sections will survive termination: Payment Terms (for amounts owed), Intellectual Property, Limitation of Liability, Dispute Resolution, and any other provisions that by their nature should survive.

9. Dispute Resolution

9.1 Informal Resolution

Before initiating any formal dispute resolution process, the parties agree to attempt to resolve any dispute, claim, or controversy informally by contacting the other party and negotiating in good faith for at least 30 days.

9.2 Mediation

If informal resolution is unsuccessful, the parties agree to participate in mediation before pursuing litigation or arbitration. Mediation will be conducted by a mutually agreed-upon mediator or, if the parties cannot agree, through the American Arbitration Association (AAA). Each party will bear their own costs of mediation, with mediator fees split equally.

9.3 Arbitration

If mediation is unsuccessful, any dispute arising out of or relating to these Terms or our services shall be resolved through binding arbitration administered by the American Arbitration Association under its Commercial Arbitration Rules. The arbitration will be conducted in [State], and the arbitrator's decision will be final and binding.

• The arbitrator may award the same damages and relief as a court
• Each party will bear their own attorney's fees unless the arbitrator awards them
• The arbitrator's decision may be entered as a judgment in any court of competent jurisdiction

9.4 Exceptions to Arbitration

Either party may seek injunctive or equitable relief in court to protect intellectual property rights or confidential information without first engaging in mediation or arbitration.

9.5 Class Action Waiver

All disputes must be brought on an individual basis. You agree that you will not bring or participate in any class action, collective action, or representative action against Healix RCM.

9.6 Governing Law

These Terms shall be governed by and construed in accordance with the laws of the State of Texas, without regard to its conflict of law provisions. Any litigation not subject to arbitration shall be brought exclusively in the state or federal courts located in Harris County, Texas.

10. Changes to Terms

We reserve the right to modify or update these Terms at any time. When we make changes, we will:

• Update the "Last Updated" date at the top of this page
• Notify active Clients via email of material changes
• Post the updated Terms on our website

Material Changes: For material changes that affect your rights or obligations, we will provide at least 30 days' notice before the changes take effect. Your continued use of our services after the effective date constitutes acceptance of the modified Terms.

If you do not agree to the modified Terms, you may terminate your service agreement as outlined in Section 8.

We encourage you to review these Terms periodically to stay informed of any updates.

11. General Provisions

11.1 Entire Agreement

These Terms, together with our Privacy Policy, Business Associate Agreement (if applicable), and any service agreements, constitute the entire agreement between you and Healix RCM regarding our services and supersede all prior agreements and understandings.

11.2 Severability

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

11.3 Waiver

Our failure to enforce any right or provision of these Terms will not constitute a waiver of that right or provision. Any waiver must be in writing and signed by an authorized representative.

11.4 Assignment

You may not assign or transfer these Terms or your rights hereunder without our prior written consent. We may assign these Terms without restriction. Any attempted assignment in violation of this section is void.

11.5 Force Majeure

Neither party shall be liable for any failure or delay in performance due to circumstances beyond their reasonable control, including acts of God, war, terrorism, natural disasters, pandemics, government actions, or failures of third-party services.

11.6 Notices

All notices under these Terms must be in writing and sent to the addresses specified in your service agreement or to the contact information listed in Section 12 below. Notices will be deemed given when delivered personally, sent by confirmed email, or three days after mailing by certified mail.

11.7 Relationship of Parties

The relationship between you and Healix RCM is that of independent contractors. Nothing in these Terms creates a partnership, joint venture, employment, or agency relationship.

11.8 Third-Party Beneficiaries

These Terms do not create any third-party beneficiary rights except as expressly stated.

12. Contact Information

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