.Contact Information

Contact person:       
Practice name:        
Main office address: 
City:        State:
Email:    
Phone:    Fax: 

Comments or requests:

If you would like us to contact you, press .     

If you would like an on-line practice evaluation, continue on to Medical Practice Profile.

Return To Top  

.Medical Practice Profile

Current Billing Process:

Billing service:       Self billing: Computer   Manual 

Do you receive software updates?  yes no

Primary Concerns: (please check)

Financial:
Fees    Collection performance   Overhead
Adjustment %   Accounts receivable   Managed care contracts
Other

Insurance Filing:
Coding    Forms    Resubmissions
Accuracy    Record retention

Strategy & Analysis:
Current business condition    Contract performance    Negotiation
Strategic planning    Agreements/Contracts    Growth potential    
Marketing

     Continue to Financial Analysis

or Return To Top.

.Financial Analysis

1. Annual charges #: and $:
2. Annual collections $:
3. Total A/R: $    >120 Days  A/R: $ 

4. Third party payers you participate with:

5. Contractual write-offs:  $
(Do not include collection agency, small balance or bad debt write-offs.)

6. Patient mix (%):
Blue Shield     Private insurance     Medicare     Medicaid
Workers Comp.     Managed care     Champus     Private pay

7. Collection agency write-offs:  $
8. Minimum account balance sent to agency:  $
9. Point of aging process at collection agency:

Return To Top