Please take a few minutes to answer the questions on the form below. When complete, click the "Submit Form" button at the bottom of the page. Your form will be emailed to our staff. We will call you to discuss the results and how we can be of assistance to your business.

If you would like to print a form to complete offline, click here. A window will open with a printable form.

Contact Information-

Contact Name:
Company Name:
E-Mail Address: Required

Survey Your Cash Flow Success

1) Are your outstanding accounts receivable balances at an acceptable level: Yes No
30 days at 8–12% of total?
60 days at 3–7% of total?
90 days at 1–5% of total?
120+ days at 13–17% of total?

2) Does your accounts receivable staff devote the necessary time each month to managing your receivables? Yes No

3) Are Medicare and Medicaid claims submitted timely: Yes No
Medicare — within 5 business days of the end of the month?
Medicaid — by 1 p.m. the first working day of the month?

4) Are coinsurance charges billed and denied claims re-billed within one business day of remittance advice receipt? Yes No

5) Are you confident your billings are compliant with all state and federal regulations? Yes No

6) Are all aspects (AR, AP, Payroll and GL) integrated in your current software? Yes No

7) Could you have collected accounts that were written off if appropriate follow-up had occurred? Yes No

8) Would you like to save money? Yes No

9) Do you have trouble employing and retaining effective accounts receivable and billing staff ? Yes No

10) Do you need to improve your cash flow? Yes No

11) Do you need short-term assistance in collecting accounts receivable? Yes No

12) Are you unhappy with, or considering, a different financial software? Yes No


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