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Request a Price Quote

Thank you for your interest in GS3 Medical Billing. The information requested below will help us prepare a price quote for your practice. Please return the requested information below at your earliest convenience and we will prepare a proposal for your review and consideration. Please do not hesitate to contact us at 877 473 6288 if you have any questions or if we can assist you in any manner.

If you are not able to or reluctant to answer any of the questions, a telephone conference may be appropriate. Please feel free to enter as much information as you choose and submit the form so that we may contact you.

Practice Name
Client Contact Name
Address 1
Address 2
Number of Providers
1. Total Billing for the last 6 months preferably on a monthly basis:
2. Practice specialty:
3. Total collections for the last 6 months preferably on a monthly basis:
4. Total adjustments for the last 6 months - preferably on a monthly basis:
5. Payor Mix average percentage of Medicaid, Medicare and Third Party Insurers (percentage estimates):
6. Average number of patients seen in clinic per day per provider:                          
    Average number of days in a month the provider see patients in the office:         
7. Avg number of days in a month the doctor sees patient in the office:                  
8. Average number of procedures/surgeries/visits in hospital per day per provider:  
9. Any anticipated changes in provider staff over the next year, if applicable:
10. Current practice management system:
11. Does your practice generate superbills or encounter forms :
Super Bills
Notes that have to be coded
Combination of Super Bills & notes that need be coded
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