Strategic Billing Optimization Assessment Practice Name (required) Practice Owner (required) Specialty Types(s) (required) Number of Locations (required) Number of Full-Time Providers Number of Part-Time Providers (less, than 100 claims per mo.) (required) Current Billing status (required) In-houseContracted billing company Anticipate any growth of providers or locations within the next year? (required) Number of Patients Per day (required) Number of Patients Per month (required) What is your approximate patient payor base distribution? (all should add up to 100%) Commercial % Medicare % Medicaid % Self Pay % Does the Practice has any of the following: In house X-Ray Fluoroscopy Mini C-Arm Large C-Arm DME License Does the practice perform any in-office procedures and/or minor surgeries? (required) Does the practice have any current Ancillary Revenue Streams? (required) Does your practice currently use an EHR? (required) YesNo If yes, what system do you currently use? How do you currently process claims? (required) OutsourceInhouse Who is responsible for coding your claims before you submit them? (required) When was the last time your claims were reviewed by a certified coder? (required) When was the last time your last Medicare/CMS claim audit? (required) How did your last audit go? Please add all comments here.(required)
