Group/Physician Name

Primary Office Contact

Position

Office Address

City, State, Zip

Phone

E-Mail Address

Do you currently process billing “In-House”               

How many employees do you employ to do billing?

What is the name of you current Practice Management Software?

Do you participate with Medicare?

Do you submit claims electronically? 

   If Yes, Do you submit most claims electronically or just Medicare Claims?

Approx. how many Medicare claims do you process each month?

Approx. how many Commercial Insurance claims do you process each month?

Approx. how many Patient Statements do you send out each month?

**What are your average Monthly Charges?

**What are your average Monthly Collections?

** What is your current Accounts Receivable (Total Amount Due You)?

**This information will allow me to give you a more accurate Quote, 
but is not necessary to obtain an estimated Quote.

How many Active (seen within last 2 years) Patients do you have?

Average number of Patients

Monthly

Average number of NEW Patients seen weekly?

monthly?

Do you verify insurance coverage on all New Patients?

Do you have balances that are over 60 days, and have not been followed up on?

What percentage of you’re A/R would you say is over 90 days?

Do you have someone in your office that regularly (at least weekly) works on unpaid claims?

Do you file appeals for unpaid claims?

Do you currently send Birthday Cards to your patients?

Do you currently send Welcome Cards to your New Patients?

Do you currently use a recall system to remind patients of the need to return to the office for care (i.e. orthotic checks, routine care, therapeutic shoes, etc)?

What is the worst problem(s) that you experience in your practice with regards to billing or Practice Management? 

Is there something particular that your practice does with regards to Billing or Practice Management that you are pleased with, and would not want to change?