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