ASSURED BUSINESS SUPPORT SERVICES    

P.O. BOX 1226, EASTON  MA  02334

Telephone: (508) 230-3377     Fax: (508) 230-1771

                                     

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PROVIDER QUESTIONNAIRE

Please fill out the form below with as much detail as possible and press the Submit button:

1. Number of commercial insurance claims per month: 

2. Number of Medicare claims per month:

3. Number of  Medicaid claims per month:

4. Estimate the hours per day that are spent processing claims:

5.  Estimate the salary per hour of the person who processes your claims: 

6. Length of time it  takes  to receive payments for the average claim:  days

7.  Average percent of rejected claims per month:

8.  How are past due accounts handled?

9.   Do you currently use a billing service company? Yes  No

  If yes, do you pay a percentage or a flat fee? Flat %

________________________________________________________

Name:  

Practice Specialty:

Street Address:   

City, State & Zip:  

Daytime Phone:    

 

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