Practice Analysis Questionnaire Your Info: Practice Name* Phone Number* Email* Practice Website* Practice Representative:* Office Manager, Staff Practice Owner:* Number of Providers Full time Part time 100 claims or less per month Specialty: Appointment Confirmation How many staff hours are spent daily on confirming patient appointments? Do you have issues with NO-SHOWS? YesNo If yes, How many NO-SHOWS per day? Patient Eligibility How many hours are spent daily on verifying patient eligibility? Back Office How much time is spent on pulling and re-filling patient charts daily? How many staff hours are spent daily on providing patients medical records? Billing Who is responsible for coding your claims before you submit them? FT StaffPT StaffOutside Company How do you currently process claims in your office? OutsourceIn House IF OUTSOURCE BILLING: How much do they charge? % of collections What is your claims rejection, denial, or non-payment rate? (On average, practices suffer a 30% rejection rate) How many hours are spent weekly by your staff members on billing and collection related activities? How much on average is collected per month (Total Revenue) Who does your Credentialing? OutsourceIn House Do you currently utilize a Collection Agency? YesNo IF NO, How much time is spent daily, by your staff on collection attempt? How much time does your staff spend daily on sending out patient statements? How much time does your staff spend daily handling calls with billing issues? Do you have a patient retention program, such as sending patient's birthday cards, holiday cards, annual check-up reminders, etc.? YesNo IF YES, How much time is spent on this?