Inquire About Improving Your Cash Flow & Maximizing Your Revenue

Please Share a Brief Overview of your Business for a Better Understanding of your Needs.

Individual's Name*

Individual's Name*

Name of The Healthcare Provider Facility*

Name of The Healthcare Provider Facility*

What is your agency NPI*

What is your agency NPI*

Type of Provider Facility (please select all that applies to you)*

Type of Provider Facility (please select all that applies to you)*

Please provide the best phone number to contact you*

Please provide the best phone number to contact you*

Please provide the best email address to communicate and send follow-up documents*

Please provide the best email address to communicate and send follow-up documents*

Which of these Services Describe Your Need?*

Which of these Services Describe Your Need?*

For Billing Team Coaching and Consulting Services ONLY, please describe your current challenges.*

For Billing Team Coaching and Consulting Services ONLY, please describe your current challenges.*

What Stage of Growth is Your Facility?*

What Stage of Growth is Your Facility?*

Insurance Types Currently Billed by Your Agency*

Insurance Types Currently Billed by Your Agency*

What is Your Relationship with Agency?

What is Your Relationship with Agency?

Do You Have In-House Medical Billing Staff?*

Do You Have In-House Medical Billing Staff?*

Are You Currently Using an Outsourced Medical Billing Service?*

Are You Currently Using an Outsourced Medical Billing Service?*

What is your desired outcome?*

What is your desired outcome?*


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