Medical Billing Form

Physician office (family practice, medical clinic, etc.)

Medical billing service company

Hospital

Physical therapy practice (chiropractic office)

Psychologist practice (mental/behavioral health)

Dental practice

Medical equipment company (DME)

Other (please specify):

No - our practice/business does not currently use medical billing

No - this is for a new practice/business or office

Yes (please indicate which solution, if known):

Not sure

Billing and collections

Appointment scheduling

Insurance claim submission/management

Electronic medical records (EMR)

Patient records management

Reporting

Other (please specify)

1-2

3-5

6-10

11-25

25+

5-10

10-20

15-20

20-25

25+

Immediately

Within two months

Between two and four months

More than four months