Health Information Technology

Practice Assessment Questionnaire

Contact Information

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10. Administrator
11. Administrator's Email Address

About Your Practice and Staff


12-a. Please specify other practice specialty


13. Number of Locations
14. Staffing Levels
Please indicate the numbers of the following staff:
14-A. Physicians
14-B. Other Providers - PA, NP
14-C. Nurses and Other Clinical Staff
14-D. Front Office Staff (Check In/Check Out, Clerical)
14-E. Medical Records Staff
14-F. Billing Staff
14-G. Dedicated Charge Entry Staff
14-H. Dedicated Payment Entry Staff
14-I. Administrative Staff
14-J. Transcription Staff
14-K.

15. What Systems Do You Currently Have In Place?

System Current System Reason for Replacement
(Check all that apply. Hold down the control key to select more than one option.)
Timeframe for Replacement
Practice Management and Revenue Cycle Management System(s) (PM-RCM)


Please specify other PM-RCM


Please specify other reason for replacement of PM-RCM
Electronic Health Records (EHR)

Please specify other EHR

Please specify other reason for replacement of current EHR

Goals for the Practice

16. What are your short term goals for the practice? (Ex: decrease operational costs) Select all that apply. Hold down the control key to select more than one option.

16-a. Please specify other short term goals

17. What are your long term goals for the practice? Select all that apply. Hold down the control key to select more than one option.

17-a. Please specify other long term goals


18. What are the biggest challenges with the current, paper-based workflow? Select all that apply. Hold down the control key to select more than one option.

18-a. Please specify other challenges

Electronic Health Records (EHR)

19. Do you have any concerns with moving to EHR? (Select All that Apply. Hold down the control key to select more than one option.)

19-a. Please specify other concerns

Current Process and Procedures

20. Describe how a patient moves through the practice � from check in to check out

21. How do the physicians currently document? Select all that apply. Hold down the control key to select more than one option.

22. Please specify other way(s) that physicians document

23. Approximately how much do you spend monthly on transcription costs?

24. Approximately how many patients a day does each physician see?

25. Chart pulls per day? (Estimated)

26. Refills per day? (Estimated)

27. Average dollars per visit? (Estimated)

28. Reimbursement for 99213? (Estimated) (Established Patient Office or Other Outpatient Visits)

29. Reimbursement for 99214? (Estimated) (New Patient.)

30. How are phone requests routed?

31. How are clinicians alerted that a patient is waiting in the exam room?

32. What primary forms are being used?

33. Who are your lab Vendors? (Select all that apply. Hold down the control key to select more than one option.)

34. How do you file, report and manage lab results?

35. How do you track/report/alert disease management protocols or risk factors?

36. What data (if any) does your ancillary staff contribute to the note?

37. What are the EHR hot buttons/critical issues?
(Please check all that apply. Hold down the control key to select more than one option.)

37-a. Please specify other hot-button/critical issue(s)

Practice Management

38. To whom do you currently transmit electronic claims?
Please check all that apply. Hold down the control key to select more than one option.

39. Please specify other electronic claims processor

Centralized Scheduling and Registration

40. Do you use centralized scheduling and registration?

41. Do you require full registration prior to patients being seen?

42. Do you have any special scheduling needs?

Charge Entry and Billing

43. Are charges entered at the time of service?

44. If not, when are they entered?

45. How And When Are Copays/Coinsurance Collected?
45-A. When are copays/coinsurance collected?

Please specify other time and for collecting copays/coinsurance

> 45-B. How are copays/coinsurance collected?

Please specify other way copays/coinsurance are collected

46. Speacial Billing Needs
46-A. Do you have any special billing needs such as UBs, anesthesia or DME?
46-B. Select special billing needs. Select all that apply. Hold down the control key to select more than one option.
46-C. Please specify other special billing needs
Billing, Aged Balances, Financial Reporting
47. Do you use centralized billing?
48. How do you currently check eligibility? Select all that apply. Hold down the control key to select more than one option.

48-a. Please specify other way of checking eligibility

49. Do you currently utilize electronic posting?

49-a. If you use electronic posting, Which carriers?

50. What is your current clearinghouse for EDI?

51. How do you currently work your aged insurance balances?

52. Do you have a collections process or collections staff?

53. Is your collections process centralized?

54. What is the current process for follow up on aged patient balances?

55. Do you use an outside collection service?

56. What financial reports are you using today to manage your business? Select all that apply.

56-a. Please indicate other financial reports you use.

57. Do you have a �wish list� of reports you currently do not have?

58. What reporting tools do you currently use?

59. Do you track and report on productivity utilizing RVU/RBRVS?

RBRVS is the Resource-Based Relative Value Scale.
RVU is the Relative Value Unit used by the RBRVS.



Thank you for taking the time to complete our questionnaire!