PRIVATE REVENUE INFRASTRUCTURE INTAKE

PRIVATE REVENUE INFRASTRUCTURE INTAKE

This intake functions as a pre-engagement operational and revenue assessment. We require detailed front-end and back-end information to determine alignment, readiness, and scope. Submissions without complete documentation will not be reviewed. Approved organizations will receive a private consultation invitation within 24 hours.
Practice Identification

Tell us about your practice.
Practice Name*
Practice Website
Practice Specialty*
Practice Contact Person Full Name*

First NameLast Name
Contact Email Address*
example@example.com
Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Practice Location Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Practice Scale and Systems

Share details about your patient volume and technology.
Average Monthly Patient Visit Volume*
Which EHR (Electronic Health Record) system do you use?*
Other Key Systems Used (PM, Clearinghouse, etc.)
Front-End Revenue Operations

Describe your intake and front-end processes.
How are patient intake and registration handled?*
Number of staff involved in front-end revenue operations (intake, eligibility, prior auth, etc.)
Eligibility verification issuesPrior authorization delaysIncomplete documentationPatient demographic errorsInsurance capture errorsOther
Back-End Revenue Operations

Describe your billing and A/R processes.
How is billing handled?*
Number of staff involved in back-end revenue operations (billing, posting, follow-up, etc.)
Claim denialsA/R follow-up delaysPayment posting errorsUnderpaymentsOther
Accounts Receivable Documentation

Please upload your most recent A/R aging reports.
Upload your latest Insurance A/R Aging Report (with payer detail and aging buckets)*

Cancelof
Upload your latest Patient A/R Aging Report (with payer detail and aging buckets)*

Cancelof
Revenue Performance Snapshot

Share your current A/R and denial metrics.
Total A/R Outstanding (USD)*
What percentage of your A/R is over 90 days old?*
Who is your largest payer by volume?*
Eligibility issuesAuthorization issuesCoding errorsTimely filingOther
KPIs and Oversight

Help us understand your monitoring and oversight structure.
Days in A/RClean claim rateDenial rateNet collection rateOther
How frequently are KPIs reviewed?
Who is responsible for KPI oversight?
Leadership and Readiness

Share your goals and expectations.
What are your main reasons for seeking medical billing support?*
What would stability in your revenue cycle look like for you?*
Alignment Confirmation

Help us ensure the right fit.
YesNoUnsure, would like to discuss
Should be Empty:

PRIVATE REVENUE INFRASTRUCTURE INTAKE

Practice Identification

Practice Scale and Systems

Front-End Revenue Operations

Back-End Revenue Operations

Accounts Receivable Documentation

Revenue Performance Snapshot

KPIs and Oversight

Leadership and Readiness

Alignment Confirmation