Med-Kick Reassignment of Benefits Agreement

Last Revised Date: October 28, 2025

This Reassignment of Benefits (“Reassignment”) is entered into by and between the Provider (“Provider”) and Med-Kick, Inc. (“Med-Kick”), and is incorporated into and made part of the Master Services Agreement (“MSA”) executed between the Parties.

1. Purpose: Pursuant to 42 C.F.R. § 424.80, Provider hereby reassigns to Med-Kick the right to submit claims and receive payment from Medicare and other payers for specific services rendered by Med-Kick under Provider’s supervision and billed under Provider’s NPI/TIN in accordance with applicable Medicare and commercial payer rules.
2. Scope: This Reassignment applies solely to the CPT codes and services listed in Appendix A in the MSA agreement– Scope of Services and Covered CPT Codes. No other services or billing categories are covered under this reassignment. Med-Kick will furnish clinical, technical, administrative, and billing services “under arrangement” on the Provider’s behalf.

3. Authorization of Reassignment: Provider expressly agrees to reassign its right to receive payment for the covered services to Med-Kick. This reassignment is made in accordance with applicable Medicare guidelines, including 42 CFR §424.80 and CMS Form 855R, and any commercial payer equivalents.

4. EFT Authorization: Provider authorizes Med-Kick to receive direct reimbursement via electronic funds transfer (EFT) for the services billed under Provider’s NPI and TIN, limited to the CPT codes in Appendix A – Scope of Services and Covered CPT Codes. Provider agrees to cooperate in supporting any enrollment updates, EFT routing changes, clearinghouse setup, or other necessary actions to ensure Med-Kick receives payment directly.

5. Billing and Claims Submission: Med-Kick shall submit claims for covered services directly to applicable payors, using the Provider’s NPI/TIN where necessary, and will comply with applicable billing standards. Med-Kick assumes full responsibility for claims preparation, documentation, and audit readiness related to the reassigned services.
6. Compliance: Both Parties shall comply with all applicable federal and state laws, including Medicare regulations, fraud and abuse laws (Fair Market Value, AKS/Stark compliance, HIPAA), and billing compliance requirements. Med-Kick shall maintain detailed records for at least 4 years and provide access upon reasonable notice.
7. Term and Termination: Termination of this Reassignment of Benefits Agreement shall follow the same notice period outlined in the terms and conditions of the MSA, unless otherwise specified herein. Termination of the Reassignment shall not impact claims already submitted or funds received.

IN WITNESS WHEREOF, the parties have executed this Reassignment as of the date of the MSA as separately signed below. This Reassignment of Benefits Agreement (Appendix C) is fully binding and incorporated into this MSA.”