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Free Revenue Analysis   Physician Billing Services - Free Revenue Analysis Legal practice name: Main office address: City, State, Zip: Contact name: Phone number:    Fax:  Email address: Specialties: Number of physicians: Physician extenders: Number of patients per day: Office      Hospital      New patients    Does the practice bill multiple fee schedules?     Yes      No     If yes, how many? Percentage of Medicare allowable: % Does the practice participate with - Medicare       Medicaid Current payor mix: % Medicare % Medicaid % BCBS % PPO % HMO/POS % Self Pay % Commercial Does the practice file commercial insurance for patients?     Yes      No   Is this done as a courtesy only? (i.e. payment made at time of service)     Yes      No   What are the average monthly collections/revenue? What are the average monthly gross charges? What are the current accounts receivable total? Amount over 90 days? Do you routinely write-off bad debt accounts and accounts that are transferred to collection?     Yes      No   If yes, % of total accounts receivable?