HIPAA Survey


Are the computer systems in your office HIPAA-compliant? *	Yes No
Does your office file claims electronically? *	Yes No
Is your office prepared, or preparing, to meet Medicare’s electronic claims submission requirement, as well as received individual provider NPI numbers for each physician within the practice? *	Yes No
How long does it usually take for you to receive payment from insurance carriers? *
How much does it cost you to file a claim? *
On average, how many claims do you submit per month? *
What percentage of claims that you submit are rejected? *
How much time and money is lost from unpaid/rejected claims? *
Would your practice benefit from receiving payment faster, with fewer rejected claims? *	Yes No
Do you have an employee assigned to follow up on unpaid/rejected claims? *	Yes No
Would your office operate more efficiently if you had someone to concentrate on billing, allowing your staff to focus on patient care? *	Yes No
Name of Office Manager or Point of Contact *
Contact Phone Number *
Email Address *