Terms of Service

1. Services Provided

MedCodex Health provides professional healthcare revenue cycle services including, but not limited to:

• Medical coding (inpatient, outpatient, professional fee, and specialty coding)
• Clinical Documentation Improvement (CDI) program support
• Physician query management
• Coding quality audits and compliance reviews
• Risk adjustment and HCC coding
• Medical necessity review
• Discharge summary review
• Telemedicine documentation support

The specific scope, deliverables, turnaround times, and fees for services are defined in a written Service Agreement or Statement of Work (SOW) executed between MedCodex Health and the Client.

2. Client Responsibilities

The Client agrees to:

• Provide complete, accurate, and legible medical records and documentation required for coding services
• Maintain all necessary authorizations, licenses, and certifications required to operate as a healthcare provider or revenue cycle entity
• Designate an authorized representative responsible for communication and approvals
• Review and validate all coded output and reports in a timely manner
• Promptly notify MedCodex Health of any coding guideline changes, payer-specific requirements, or system updates that may affect our services
• Ensure that all data shared with MedCodex Health is transmitted through secure, approved channels
• Execute a Business Associate Agreement (BAA) prior to sharing any Protected Health Information (PHI)

3. HIPAA & Regulatory Compliance

MedCodex Health operates as a HIPAA Business Associate. Both parties agree to comply with all applicable provisions of HIPAA, the HITECH Act, and associated regulations. A separate Business Associate Agreement shall govern the handling of all PHI.

The Client, as the covered entity, remains ultimately responsible for ensuring that all billing and coding submissions to payers comply with applicable laws including the False Claims Act, Anti-Kickback Statute, and all CMS and payer-specific billing guidelines.

MedCodex Health provides coding based on documentation provided by the Client. The accuracy of underlying clinical documentation is the responsibility of the treating providers and the Client organization.

4. Coding Accuracy & Quality

MedCodex Health applies industry-standard quality assurance processes and targets a minimum coding accuracy rate of 98% (measured against official coding guidelines). However:

• Coding accuracy is contingent on the completeness and quality of clinical documentation provided
• MedCodex Health is not liable for coding errors arising from incomplete, illegible, or ambiguous documentation
• The Client is responsible for final review and submission of all claims
• Any disputes regarding coded output must be reported in writing within 30 days of delivery

5. Confidentiality

Both parties agree to maintain strict confidentiality of all proprietary information, trade secrets, business processes, patient data, and financial information exchanged during the engagement. This obligation survives the termination of services for a period of five (5) years.

All MedCodex Health employees and contractors with access to Client data execute confidentiality and non-disclosure agreements prior to any data access.

6. Fees & Payment

Service fees are specified in the executed Service Agreement or SOW. Unless otherwise agreed:

• Invoices are issued monthly based on volume of charts coded or services rendered
• Payment is due within 30 days of invoice date
• Late payments may incur interest at 1.5% per month or the maximum permitted by law
• MedCodex Health reserves the right to suspend services for accounts overdue by more than 60 days

7. Intellectual Property

All coding outputs, reports, and deliverables produced for the Client become the property of the Client upon full payment. MedCodex Health retains ownership of all proprietary methodologies, workflows, software tools, training materials, and quality frameworks developed independently.

8. Limitation of Liability

To the maximum extent permitted by applicable law:

• MedCodex Health's total liability for any claim arising from our services shall not exceed the total fees paid by the Client in the three (3) months preceding the claim
• MedCodex Health is not liable for indirect, incidental, consequential, or punitive damages
• MedCodex Health is not liable for payer denials, audits, or recoupments arising from the Client's clinical documentation deficiencies or billing decisions
• MedCodex Health is not liable for regulatory penalties resulting from the Client's non-compliance with applicable healthcare laws

9. Indemnification

The Client agrees to indemnify, defend, and hold harmless MedCodex Health, its officers, employees, and contractors from and against any claims, damages, losses, or expenses (including legal fees) arising from: (a) the Client's breach of these Terms; (b) the Client's violation of applicable laws or regulations; (c) inaccurate or incomplete documentation provided to MedCodex Health; or (d) the Client's billing or claim submission decisions.

10. Term & Termination

The service engagement commences on the date specified in the Service Agreement and continues until terminated. Either party may terminate services with 30 days written notice. MedCodex Health may terminate immediately if the Client breaches HIPAA obligations, fails to pay overdue invoices, or engages in fraudulent or illegal activity.

Upon termination, all PHI in MedCodex Health's possession shall be returned to the Client or securely destroyed in accordance with the BAA.

11. Governing Law

These Terms are governed by the laws of Tamil Nadu, India, and applicable Indian federal law, without regard to conflict of law principles. For U.S.-based clients, disputes involving HIPAA or U.S. federal healthcare law shall be subject to applicable U.S. federal law. Any disputes shall first be attempted to be resolved through good-faith negotiation.

12. Modifications

MedCodex Health may update these Terms periodically. Continued use of our services after notice of changes constitutes acceptance of the updated Terms. Material changes will be communicated to active clients in writing with at least 30 days notice.

13. Contact