Medical Billing Professionals:: Reimbursement Evaluation

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414-479-3300

Reimbursement Evaluation

The Reimbursement Evaluation will allow us to be very specific about what MBP can do in terms of improving your reimbursement per visit and the aging of your receivables. It will help you to determine the upside potential of Outsourcing. The information you send will be kept strictly confidential.

Data Requirements

(*) Indicates a required field.
Your Full Name *	:
Company *	:
Address *	:
Phone Number *	:
Contact Email Address *	:
Comments/Explanation	:

Month/ Year *
Gross Charges *
Collections *
Adjustments *
Month End AR *
Visits *
New Patients *

*Do not include capitated or case rate data for this analysis

Please estimate the percentage of total patient visits from Medicare, private insurance and Workers’ Comp. You need not estimate each month separately, a general estimate will be fine.

% of visits from Medicare per month =	%
% of visits from from private/commercial per month =	%
% of visits from Worker’s Comp per month =	%

Aging Report: Please list dollar amount for each aging period

< 30 days
31-60 Days
61-90 Days
91-120 Days
120> Days

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