"Exactly how much are
you spending on
insurance claims?
Completion of this
custom profile will
enable us to give an
accurate quote on
Medical Billing
Services specifically
for your practice needs"

Practice Name:    

Practice Type/
Specialty:

Physician's Name:

Physician's Phone
Number:

Office Manager/
Practice Manager's
Name:


Practice/ Office Mailing
Address:






Approximately How
Many Active
Patients Does Your
Office Have?

Approximately How
Many
Patients Are Seen Per
Day?

Approximately How
Many
Patient's Are Seen Per
Week?


Average Number Of
Claims Per Month?

Average Billed Per
Claim?




What Is The Biggest
Problem
You Or Your Billing
Staff Is
Currently
Experiencing?




Do You Experience A
Lot Of Rejected
Claims?

If Yes, What
Percentage
ID Rejected?

Do You Currently Have
A Backlog Of Claims?

How Does Your Office
Process Claims?


How Many Employees
Work
On Claims And
Accounts
Receivable?


Average Hourly Wage
Of
Each Employees?

Do You Use An
Outside Service To
Process Claims?

Are You Satisfied With
This Services?



Do You Find Filing
Insurance Claims
Time Consuming?

Would You Like To
Reduce The Turn
Around Time For
Reimbursement?



If No Please Elaborate:







Survey Filled Out By:


Title: