New Client Questionnaire
General Practice Information
- Practice Name:
- Practice Address:
- Practice Phone Number:
- Primary Contact Name:
- Primary Contact Phone Number & Email Address:
- Business Type (solo practice, group, urgent care, etc.):
- Full Name(s) of Provider(s):
- NPI Number(s):
- DEA Number(s):
- Individual and/or Group NPI:
- Are all providers credentialed with all participating insurance plans?
- What insurance plans do you currently participate with?
- Are you planning to add any additional insurance plans or payers?
- Do you accept Medicare and/or Medicaid?
- Do you have any out-of-network billing needs?
- Do you bill workers compensation or auto accident claims?
- How do you handle cash patients?
- Which EMR/EHR system do you currently use?
- Which billing software do you currently use?
- Will you allow us access to your systems (view only or full access)?
- How do you currently track denials and rejections?
- How many patients do you see per day/week/month?
- What is your current average billing turnaround time?
- Does your office have seasonal fluctuations in patient volume?
- What is your current claim submission process?
- How do you handle patient balances and statements?
- How often are claims submitted?
- How do you collect patient demographics and insurance information?
- Who handled your billing previously?
- What were your main challenges with your previous billing provider/system?
- Average days in A/R? Current A/R breakdown (if available)?
- Denial rate (if known)?
- Who handles the coding (provider, coder, billing company)?
- Are encounter forms/super-bills used?
- What documentation format do you use (templates, SOAP notes, etc.)?
- Do you have a HIPAA compliance offiicer?
- How is PHI currently stored and transmitted?
- Do you have secure file sharing methods in place?
- What are your main goals in becoming a Legacy client?
- How often would you like to receive status updates and reports?
- What is your preferred method of communication?
- What level of involvement do you want in the billing process?
