Consulting Questionnaire

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Source

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Date

Name of Practice you are representing: *

Services currently offered by your practice: *

Services your practice is considering in the future: *

Programs / Services you are currently billing for: *

Programs / Services you plan to bill for in the future: *

Is service billing currently done in-house? *

If utilizing a third party billing company, what is your current pay structure? *

What EHR / Practice Management Systems are currently being utilized? *

Are there planned changes to the clinic or operating systems in the future? *

How many providers work for the practice? *

How many total visits per day for the providers? *

Are the providers credentialing current? *

Who is responsible for processing and keeping providers credentialing updated? *

What insurance companies are you contracted with? *

Are there any insurance companies you plan to contract with in the future? *

What are the current percentages of insurance companies for your services? *

Do you currently send any statements to patients? *

What is your current practice A/R? *

What are your monthly average reimbursements? *

3 + 3 = (for authentication purpose) *

Please enter a number that represents 3 + 3

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CONSULTING Questionnaire