Billing & Revenue Strategy Session Application
Thank you for your interest in a Billing & Revenue Strategy Session. This session is designed for providers and practice owners seeking guidance related to billing operations, claim management, accounts receivable, denials, revenue cycle performance, and practice profitability. Please complete the application below so we can better understand your current situation and maximize the value of our time together.
Contact Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Practice Name
*
State(s) of Practice
*
Back
Next
Practice Information
Which best desrcibes your practice?
*
Solo Practice
Group Practice
Startup Practice
Other
Back
Next
Billing Information
Do you currently bill insurance?
*
Yes
No
Who currently handles your billing?
*
I handle my own billing
In-house Staff
Outsourced Billing Company
Multiple People
Other
Back
Next
Current Challenges
What are your biggest billing or revenue concerns?
*
Unpaid Claims
High Account Receivables
Claim Denials
Slow Payments
Eligibility Verification
Credentialing Delays
Workflow Issues
Revenue Growth
Staff Training
Other
Back
Next
Revenue Performance
Approximately how many claims do you submit each month?
*
Less than 25
25-50
51-100
101-250
250+
Do you currently have outstanding claims over 90 days old?
*
Yes
No
Maybe
Back
Next
Session Goals
What would you like to accomplish during this session?
*
Back
Next
Implementation Readiness
How soon are you hoping to implement solutions?
*
Immediately
Within 30 days
Within 60-90 days
Just exploring options
If recommendations are provided during the session, are you prepared to invest in implementing a solution?
*
Yes
Maybe
No
Back
Next
Success Question
What would make this session a success for you?
*
Back
Next
Agreements
I understand this is a paid strategy session designed to provide guidance, recommendations, and actionable next steps related to your billing operations, revenue cycle performance, claim management, and practice growth
*
I understand
I understand to ensure a productive session, all applicants must complete the application, submit payment, and select an appointment time.
*
I understand
I understand recommendations will be based on the information provided.
*
I understand
I understand that this session does not include claim follow-up, credentialing services, billing implementation, ongoing consulting, or audit services. .
*
I understand
I understand all session fees are non-refundable.
*
I understand
I understand that there are no same day appointments
*
I understand
I understand missed appointments or cancellations made with less than 24 hours' notice will result in forfeiture of the session fee.
*
I understand
I understand that there is only one reschedule allowed with a 24-hour notice.
*
I understand
I acknowledge that I have read and agree to these terms.
*
I understand
Back
Reserve My Session
Scheduling
Please Note: Sessions are available Tuesday through Thursday between 10:00 AM and 2:00 PM and must be scheduled at least 48 hours in advance.
Appointment
*
Back
Next
Payment
My Products
prev
next
( X )
Billing & Revenue Strategy Session
$350.00
$
350.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Back
Next
Signature
Submit
Submit
Should be Empty: