Medical Billing Sign up form

We’re in the business of helping doctors’ increase their patient and insurance reimbursements as well as the speed with which these payments are made.

 

Please fill out the questionaire below



Provider’s Business Name:

Provider’s business address:

City:

State:

Zip:


Provider’s full name:

Provider’s company contact number:

Provider’s Fax number:

Provider’s NPI number:

Does your office have an outsource billing service? yes no

If so, which one and why did you choose it?

Is your office computerized? yes no

Does your office file claims electronically? yes no

If so, do you file only Medicare claims electronically, or do you send electronic claims to all carriers who will accept them?

How long does it usually take before you receive payment from insurance carriers?

How much does it cost you to file a claim?

How much does your office bill per month?

How much of this figure do you collect per month?

What percentage of the claims you submit are rejected?

Would your business benefit if you received payment faster and had fewer rejected claims?

Do you have employee assigned to follow up on rejected claims?

Would your office run more efficiently if you had someone to concentrate on billing, leaving your staff free to deal with patients? yes no

Your Email:


Further comments: