Suncoast Medical
Billing
352-556-5165

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Suncoast Medical Billing
PO Box 5054
Spring Hill, Florida 34611
Office - 352-556-5165
Fax - 352-835-7613

New Client Inquiry Information
Practice Name    
Practice Address
City, State, Zip
Main Phone Number
Contact Person
E-Mail Address  

Practice Financials

Avg. Monthly Charges
Avg. Monthly Income
Total Prim/Ins/AR
Primary Ins. AR>90 days
Total Patient AR
Billing Calls Per Month
Practice Billing Information
% your practice is paying?        % 
 
In House Billing Expenses
Salaries $
Software $
Clearing House $
Statements/Postage $
Claim Forms $
Miscellaneous Information
 Let us know what propblems you are currently encountering.
Follow up not worked? Yes            No
To many denials? Yes            No
Untimely filing issues? Yes            No
Non billed patients? Yes            No
To many patient calls? Yes            No
Is your 90 days AR over 20% Yes            No
Comments:

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