REVENUE CYCLE MANAGEMENT SERVICES QUESTIONNAIRE

Thank you for your interest in Peregrine Healthcare's Revenue Cycle Management Services. Please complete the form below which will provide us with the information we need in order to provide you the best quote possible.


Practice Name
Contact Name
Average Monthly Charges
Average Monthly Payments
Average Monthly Adjustments
Aging Bucket - Current
Aging Bucket - 0-30 Days
Aging Bucket - 31-60 Days
Aging Bucket - 61-90 Days
Aging Bucket - 91-120 Days
Aging Bucket - 121+ Days
Will you want Peregrine to handle old outstanding receivables?
Current Practice Management Software being used?
Current EMR Product being used?
Who is currently handling all billing functions?
What other Peregrine Services are you interested in learning more about?





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