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First Name*

Last Name*

Email Adress*

Phone*

Provider Name*

Provider Address*

Please check the specific billing service model you are most interested in:*

Full-Service Billing (% of collected revenue model)

Partial Services (Select from the list below)

Please select one or more services below*

Claims Appeals Management

Coding- Review/Audit

Charge Entry

Patient Collections Assistance

Practice Management

Claims Submission

Responsive Customer Service

Patient Statements

Accounts Receivable Follow-up

Value-based Care (MIPS) Assistance

Denial Management

Patient Inquiry

Credentialing

Software Flexibility

Advanced Analytics

Payment Posting

U.S. based Account Management

HIPAA Compliance Assistance

Others - please explain below

Others - Explanation

What EHR/PM software solution are you using?*

What Billing Software are you using?*

What areas do you need help within your billing Department?*

Questions

What areas do you need help within your billing Department? *Please explain*

Why are you considering a change or addition to your current RCM/billing solution? *Please explain*

What is your biggest concern with your current process? *Please explain*

Do you currently bill in house? *If Yes: Please explain your current staffing level and areas of concern.*

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