In order to give you your free, instant price quote, we need some information about your practice.
This should take less than 5 minutes.
Note: We will never contact you without your permission, or share your information with anyone else.
Do you have a website? Yes No If so, please enter it here:
Type of Practice (e.g.: surgery, anesthesia, OB, mental health, etc.):*
Number of Practitioners:*
When giving the information for volume and income, please only consider claims and income for which you will want us to do the billing.
Please enter the approxmiate number of claims you will want us to bill per week:*
Please select one of the following: Average dollars received per claim. Average gross income received per week Average gross income per year
Please enter amount collected, including co-pay. Not amount billed:*
Please check off the services you would like us to include in your quote. Note: you will have the opportunity to see how different choices effect your quote on the next page. Bill out all insurance claims, and follow up on any unpaid or denied claims Keep track of authorizations/prior approvals and notify you when they are running out $ Perform insurance verifications prior to first visit $$$ Track amounts owed by patients and mail bills to them $$ Take phone calls from patients to discuss balance or insurance questions $$ Take phone calls from various practitioners in your group to answer billing questions $ Manage deposits for your practice $$$ Will you require specialized or unusual reports? $ Note: we also offer coding and practice consultation services. These are priced separately.
How did you hear about us?
I would like to start: As soon as possible Within the next month or two Within the next year Just browsing at this time
Currently my billing is handled by: I do my own billing In house billing person or staff A billing service I am just starting out
I am looking for a billing service because (please check all that apply): I want to increase revenue I want to save time I hate dealing with billing I want to reduce billing errors I am unhappy with our current biller Other
Do you have any other questions or comments?
As mentioned above, we will never contact you without your permission, or share your information with anyone. Please check one or more boxes below: Please call me Please e-mail me Please send me a brochure Please put me on your mailing list to receive notification of future speical offers and discounts. Please send me a start-up packet. (Checking this box gives us permission to contact you.) Please do not contact me at this time. If you would like us to contact you, please make sure the contact information above is correct.
