Billing and EMR Feedback

CHARGES

1. Do you feel the charges are created in a timely manner?
  Yes
No

CODING

2. How do you rate the quality of our Coding Review process?
  Excellent
Good
Satisfactory
Poor

CLAIMS TRANSMISSION

3. Do the claims get transmitted in a timely manner and are the transmission rejections worked on immediately?
  Yes
No
4. How satisfied are you with the timelines and accuracy of the claims being filed?
  Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied

PATIENT STATEMENTS

5. Are patient statements being sent out in a timely manner?
  Yes
No

PRACTICE COLLECTIONS

6. Have your revenues improved?
  Yes
No
If YES, by what percentage approximately

PAYMENT POSTING

7. Are you satisfied with the turnaround time for payment posting?
  Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
8. How do you rate the quality of payment posting?
  Excellent
Good
Satisfactory
Poor

PATIENT COLLECTIONS

9. Are you satisfied with the patient collection process?
  Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied

ACCOUNTS RECEIVABLES

10. Are you satisfied with the way your denials are being handled?
  Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied

MONTH-END REPORTS

11. Month end reports - Timeliness and effectiveness
  Excellent
Good
Satisfactory
Poor

ECW

12. ECW - ease of use
<<< Very easy to use  

Most Difficult to use >>>

1 2 3 4 5 6 7 8 9 10

13. Are you satisfied with the technical support provided for ECW?
  Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
14. Any other thoughts on ECW

CUSTOMER SUPPORT

15. Promptness of response
  Excellent
Good
Neutral
Needs improvement
Leaves a lot to be desired
16. Timeliness of resolution of issues
  Excellent
Good
Neutral
Needs improvement
Leaves a lot to be desired
17. Additional comments on customer service

OVERALL EXPERIENCE

18. How do you rate our services now as compared to last year or previous experience?
19. What can we do to further improve our services?
20. Would you recommend our services to others?
  Yes
No

INVOICE PROCESS

21. Do you receive your invoice in a timely manner?
  Yes
No
22. Is the invoice being sent to the right person?
  Yes
No

If No, please provide the name and contact details of the person the invoice should be addressed to

Name
E-mail
Phone
Mailing Address
23. Do you receive your invoice in a timely manner?
  Yes
No

If No, please specify the additional information you would like to see in the invoice

24. Kindly fill in your personal details... this will enable us to proceed further...
 
First Name:
Last Name:
Designation:
Name of the Facility/Hospital:
Location:
Email:
Phone: