RCM365 Discovery Form

Revenue Cycle Management Discovery

Comprehensive Assessment for Medicare Advantage A/R Recovery

The purpose of this Discovery is to gather essential details about your Revenue Cycle Management (RCM) processes. This information allows RCM 365 to evaluate your Medicare Advantage accounts receivable (A/R) backlog and provide tailored recovery strategies.

Practice & Operations

Contact Name:

Phone Number:

Email Address:

Practice / Facility Name:

Type of Practice (Specialty ):

Location(s):

Ownership:

Independent Group Practice

Corporate-Owned

Billing Method:

In-House Billing

Third-Party Billing Service

Accounts Receivable Overview

Approximate Medicare Advantage A/R Balance ($):

Current Number of Unresolved Claims:

Top 3 Payors by Outstanding A/R:

1. Payor Name:

Outstanding Amount ($):

2. Payor Name:

Outstanding Amount ($):

3. Payor Name:

Outstanding Amount ($):

Authorization & Predeterminations

For procedures in the $3,000–$5,000+ range, are predeterminations obtained prior to performing the service?

Yes

Are prior authorizations obtained where required?

Yes

Claims Data & Systems

Do you maintain a data file containing:

Date of Service

Patient Demographics

Resubmission Dates

Prior Authorization Dates

Number of Claims per Carrier

What billing or practice management system(s) are currently in use:

Can claim and demographic data be exported in a usable format?

Yes

Once completed, our team will review your responses and provide recommendations tailored to your practice.

Email: S.Davis@RCM365.com

Phone: (972) 571-5955