Confidential Practice Evaluation Survey

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Confidential Practice Evaluation Survey

Please take a few moments to fill out our survey. We are interested in gathering information regarding the problems facing medical practitioners, and the general operation of your office. You do not have to give us any specific contact information for your office (e.g. name, address, phone number). However, if you choose to give us your contact information, we will send you FREE comments and suggestions for your practice, along with more information about our services.

List Your Four Top Complaints Regarding Billing/Coding/Collections:

Do you currently use the Internet to access medical information?	Yes No
Are you analyzing your EOB’s?	Yes No
Do you send your claims to Arbitration?	Yes No
Do you currently use a Billing Service?	Yes No
Do you pursue claims through Fair Hearings?	Yes No

Number of Claims Processed Monthly: Electronically: On Paper:

Type of Software used to Transmit Claims?

Do you currently track the number of claims which are denied due to coding errors? Yes No

How do you keep apprised of changes in coding guidelines for your specialty?

How do you track claims lost by the carrier?

Are you reluctant to handle NF and WC because it involves too much follow-up?
Yes No

How much to you spend annually on human resources to process your claims?
$

When was the last time you updated your current fee schedule?

Which areas do you see the need to improve in your practice?

Medical Billing Collections

Receivables Purchasing Overflow Staffing

Financial Management Services Transcription/Word Processing

File Storage & Retrieval Forms/Stationary Design, Logo Design, Marketing Materials

Other Services you would like to see offered:

Thank you for taking our survey.
If you would like someone from our office to contact you regarding our services, please indicate YES below and fill out the following information about your practice.
Yes No

Your Name: Practice Name:

Address: City, State, Zip:

Telephone: Facsimile:

Specialty: Yrs. in Practice:

Business/Office Manager: Number of Employees:

Number of Physicians:

Number of Office Locations:

Other Specialties:

Number of Patients Seen Daily:

Number of New Patients Monthly:

to submit your survey.

Copyright © 2001 Medical Practice Innovations, Inc

	Medical Billing	Collections
	Receivables Purchasing	Overflow Staffing
	Financial Management Services	Transcription/Word Processing
	File Storage & Retrieval	Forms/Stationary Design, Logo Design, Marketing Materials

Your Name:		Practice Name:
Address:		City, State, Zip:
Telephone:		Facsimile:

Specialty:		Yrs. in Practice:

Business/Office Manager:		Number of Employees:
		Number of Physicians:
		Number of Office Locations:

Other Specialties:
Number of Patients Seen Daily:
Number of New Patients Monthly: