PRACTICE ANALYSIS QUESTIONNAIRE

Today's Date

Practice Name:

Practice Website *

Practice Representative *

Practice Owner *

Practice Specialty *

Address

Street Address

City

State

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea People's Democratic Republic
Republic of Korea
Kuwait
Kyrgyzstan
Land Islands
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Federated States of Micronesia
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Eswatini
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Postal code

Number of Providers:

Full-Time Providers *

Part-Time Providers *

Anticipate any growth of providers, locations or services offered within the next year? *

If yes, are marketing efforts in place to promote?

Patient Registration

What Practice Mgmt. / Scheduling System does your office use? *

Do your patients have ability to request appointments online? *

Yes
No
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If yes, is it integrated with your scheduling system? *

Yes
No
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If no, how do your patients currently schedule appointments?

Do your patients have the ability to fill out patient registration PRIOR to visit? *

Yes
No
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If yes, how exactly?

Do you have a patient portal? *

Yes
No
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Appointment confirmation

What is your current process for confirming patient appointments? *

How many staff hours are spent daily on confirming patient appointments? *

Patient Eligibility

What is your current process for verifying insurance eligibility prior to NEW patient visits? *

What is your current process for RE-verifying insurance eligibility prior to established patient visits? *

How many staff hours are spent daily on verifying eligibility? *

Check-In Process

Do you accept credit cards? *

Yes
No
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If yes, is your credit card machine integrated with your Practice Management system?

Yes
No
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Are you happy with the amount of credit card fees you are currently paying?

Yes
No
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If no, please provide a copy of your last 2 merchant statements

Can your patients make payments online? *

Yes
No
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If yes, is it integrated with your Practice Management system? *

Yes
No
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Back Office

Does your practice currently use an EHR? *

Yes
No
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If YES:

What EHR do you currently use?

What is your monthly subscription / update fees?

What is your per user fee?

Is it integrated with billing system?

How often do you contact their support department?

Do they charge support fees?

How long does it typically take to complete one patient chart encounter/visit?

Do you chart on a laptop or tablet?

Is it web-based or server based?

Can you access it from your phone?

Yes
No
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Does your EHR have an integrated fax utility?

Yes
No
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Are there any aspects of the system you are unhappy with?

Yes
No
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If yes, what exactly?

Have you looked at any other EHR’s systems?

Yes
No
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If yes, which ones?

If NO:

Why not?

Are you interested in updating to an EHR system?

Yes
No
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Have you explored at any other EHR’s systems

Yes
No
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If yes, which ERPs?

What specific features are you interested in (if any)?

What is your current method for charting patient encounters and storing patient records?

How much time is spent on pulling and re-filing patient charts daily?

How long does it typically take to complete documentation on patient visit?

What is your current process for providing patients medical records? *

How many staff hours are spent daily on providing patients medical records? *

Do your patients have the ability to obtain their medical records online? *

Where do you currently store your inactive patient charts? *

If stored offsite, how much is spent on storage fees per month?

Do you have a disaster recovery solution in place for your patient charts? *

Yes
No
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Check out

Do you send orders to labs? *

Yes
No
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If yes, how much time is spent daily on communicating lab results?

Do you have an automated way to send lab orders electronically? *

Yes
No
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If yes, do the lab results come back automatically attach to the patient’s chart?

Yes
No
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Do your patients have the ability to check lab results online? *

Yes
No
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Do you current send prescriptions electronically? *

Yes
No
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If yes, can you send controlled substances electronically?

Yes
No
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Do your patients have the ability to request prescription refills online? *

Yes
No
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If no, what is the current process for refilling prescriptions?

Billing

Who is responsible for coding your claims before you submit them? *

When was the last time your claims were reviewed by a certified coder? *

How do you currently process claims in your office? *

OUTSOURCE
IN-HOUSE
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IF OUTSOURCE billing:

What company do you use?

Do you have access to their system?

How do you get your claims info / EOB's to them?

How much do they charge? % of collections

What services do they provide?

How many hours each week are spent by your staff members on billing and collection related activities?

IF IN HOUSE billing:

What billing system is being used?

Is it integrated with your practice management system?

Yes
No
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What are your monthly clearinghouse + billing system + software support fees?

How many hours each week are spent by your staff members on billing & collection related activities?

What is the process for handling rejected and denied claims? *

How many insurance claims are you filing per month? *

Any surgeries? *

Yes
No
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If yes, how many a month?

On average, practices suffer a 30% claim rejection, denial, or non-payment rate. Would you say you are about average? *

How much on average is collected per month (total revenue)? *

How much is in insurance A/R (total due from insurance companies)? *

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)

If Medicare is over 25%: How prepared are you to submit your MIPS/MACRA data? *

Who does your credentialing? *

OUTSOURCE
IN-HOUSE
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If in house, how many hours on spent on this task weekly?

Any insurance or government carriers you would like to enroll with? *

Do you have any issues with denied/ rejected claims regarding network contracts?

If Outsource: How much do they charge?

How much is in patient accounts receivable (total due from patients)? *

If yes, which one?

How much do they charge?

Does it integrate with your billing system?

Yes
No
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What is the process?

How successful are they?

If no, why not?

What are your internal collections methods?

How successful are you?

How much time is spent daily on this?

Who is responsible for sending out patient statements? *

How much time is spent daily on handling patient’s call? *

When was your last Medicare/CMS claim audit? *

How did it go? *

What have you done to prepare for future audits? *

How prepared are you to illustrate HIPAA compliance when audited? *

Do you have a patient retention program, such as sending patient’s birthday cards, holiday cards, annual check-up reminders, etc.? *

Yes
No
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If yes, how?

How much time is spent on this?

If no, any interest in creating a patient retention program?

Are there any areas of your practice that you would like to enhance performance / efficiency? *

Contact Details

First Name *

Last Name

Email *

Phone *

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