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Physician Agreement Paperwork

Below you will find the documents you will need and guidance through the process.  
Setting expectations for the Provider will help immensely in this process and will allow for an easier boarding process for everyone. Our install times right now are very attractive and if all I's are dotted and T's crossed, the process has transpired within 3 weeks from signature to install. Providers are accustomed to much longer waits for new tech to deploy, so use this to your advantage.

Be sure to read "About the Agreements" that follow the downloads.

Agreement Request Form

This needs to be filled out and submitted to Corporate Contact: and cc'd to your Mangers and Master Manager. 
BIOSENSOR Phys - Agreement Request Form.pdf
File Size: 31 kb
File Type: pdf
Download File


BIOSENSOR FAQ - Insurance for Consultants.pdf
File Size: 579 kb
File Type: pdf
Download File

BIOSENSOR FAQ - Legal.docx
File Size: 169 kb
File Type: docx
Download File

Details, FAQs & Protocols

The Agreement  Documents

​All documents below are required in boarding of your provider. 
BIOSENSOR About Agreement Documents.pdf
File Size: 282 kb
File Type: pdf
Download File


BIOSENSOR - 1 - Equipment Lease.docx
File Size: 52 kb
File Type: docx
Download File

BIOSENSOR - 2 - Space Lease.docx
File Size: 46 kb
File Type: docx
Download File

BIOSENSOR - 3 - Mgmt Services Agreement,docx
File Size: 38 kb
File Type: docx
Download File


BIOSENSOR Phys - Log Sheet.docx
File Size: 652 kb
File Type: docx
Download File

BIOSENSOR Phys - Billing Form with FAQ.pdf
File Size: 139 kb
File Type: pdf
Download File

BIOSENSOR Phsy Taxonomy Crosswalk.pdf
File Size: 146 kb
File Type: pdf
Download File


About the Biosensor Documents

Our business model is to place our equipment, an employee paid by us and our supplies in your practice to help provide diagnostic services to patients you deem eligible in a space of your office that you lease to us. To keep this arrangement legal and revenue earning on both sides, we provide you with three agreements. The first two documents cover how we can place this device without any investment on your behalf.

1.  Equipment and Staffing Lease Agreement
If you are a credentialed practice that provides medical services to patients, Biosensor will lease equipment that can be used in the service to help diagnose those patients, staff trained to run the equipment and all the supplies needed to run the equipment. We retain ownership of the machine as to not violate anti-kickback laws. The lease is typically $500/month. Whatever we lease the equipment, staff and supplies for we pay an equivalent amount back in the space lease agreement.
In this document, the amount of time the equipment will be used is estimated at approximately seven minutes per test. Biosensor retains ownership of the device, keeps insurance on the device and will keep the equipment in good repair. The initial agreement is for two years, but either side can terminate with notice.

2.  Space Lease Agreement
  • Biosensor will lease the space in which the device and employee will be place.
    This lease is equivalent to the amount of the Equipment and Staffing lease (in most states, $500).
      
  • The physicians will send qualified patients for diagnostic services and make physicians available to interpret the diagnostic results.
       
  • The practice will keep the space we lease from them in good repair and will keep up with insurance  payments and taxes paid on the practice. This agreement is also for two years and can be terminated by either party.

3.  Management Services Agreement
This document covers the business relationship between Biosensor and The Practice.

The salient features of this agreement are:
  • Biosensor will act as the manager that will furnish the physician’s office with all services and material related to the ongoing operation and billing of the ANS1 device. We will provide all bookkeeping in terms of collection and fees.
       
  • We enter into a business relationship where we use our billing company (P and L Billing, Houston, TX) to bill on the physician’s behalf using the physician’s NPI for interpretations of diagnostic reports generated by the ANS1
       
  • For insurances that allow us to split up the billing for the diagnostic and professional services, we will bill use our medical director’s NPI for the diagnostic test and bill on the physician’s behalf using the physician’s NPI for the professional interpretation.
       
  • For insurance that pay globally, such as Medicare and Medicaid, our billing company will bill on the physician’s behalf using the physician’s NPI.
      
  • All insurance payments due to the physician come directly to the physician.
      
  • The physician’s practice agrees to compensate Biosensor 20% of its net insurance collections for the calendar month. Our bookkeeper will keep track of all collections and prepare the invoice for the practice. The 20% fee was determined to be fair market value for the management services provided by Biosensor.
      
  • The 20% management fee is due ten days after receipt of the invoice.
      
  • The practice should retain appropriate insurance, but will not require an umbrella policy for the device.
      
  • Both parties agree to comply with HIPAA laws
    ​  
  • Biosensor, as the manage, will not attempt to solicit or compensate the practice for referral of qualified patients.
       
A downloadable version of "About the Agreements" is provided above.

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