PRACTICE ANALYSIS QUESTIONNAIRE

Free Practice Analysis

Before you schedule a demo please tell us about your practice so we can show you appropriate pricing and have a C & C Medical Administration consultant contact you to build a customized solution. This form takes less than 10 minutes.
What type of solution are you looking for?*
How many locations does your practice have?*
Does your practice currently use an EHR?*
If Yes, What EHR do you currently use?
Are there any aspects of the system you are unhappy with?, If yes please explain
How much do you pay for EHR every month?

How do you currently process claims in your office?*
IF OUTSOURCE billing:
What company do you use?
Do you have access to their system?
How much do they charge? % of collections
IF IN HOUSE billing:
What billing system is being used?
Is it integrated with your practice management system?
What are your monthly clearinghouse + billing system + software support fees?
How many hours each week are spent by your staff members on billing and collection related activities?

What is your approximate patient payor base distribution? (all should add up to 100%)
Commercial *%
Medicare * %
Medicaid * %
Self Pay * %
Worker's comp/PI (if any) * %
Number of Providers in your practice*
Any Nurse Practitioner or Physician Assistant?*
How would you describe your practice?*
What's your specialty?*
If other, please specify specialty
On average, practices suffer a 30% or more claim rejection, denial, or non-payment rate. Would you say you are about average?*
Average number of patients seen per day?*

How many insurance claims are you filing per month?*
Any surgeries?... If yes How many?*
How much on average is collected per month (total revenue)?*
How much is in insurance A/R (total due from insurance companies)?*
Do you have a patient portal?*
Do your patients have ability to request appointments online?*
How is your current process for confirming patient appointments?*
How is your current process for verifying insurance eligibility prior to NEW patient visits?*
How is your current process for re-verifying insurance eligibility prior to established patient visits?*
How long does insurance carriers take to pay claims to your practice? (A/R days average)*

Patient Eligibility
What Form is your billing completed on?*
Do you have a disaster recovery solution in place for your patient charts?*
Do you have any file cabinets in your practice or stored in a different place?*
Are there any areas of your practice that you would like to enhance performance / efficiency?

Let’s finish up! Who do we have the pleasure of working with on this Practice Analysis request?
First Name*
Last Name*
Job Title*
Phone Number*
Please Schedule a Demo*
DateTime
Your Time Zone
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Free Practice Analysis