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Practice Management Service Request Form

If you are a health professional seeking assistance with your practice, take advantage of our practice management services by filling out the following service request form, or you contact us at 706-660-2499.

Items marked with an asterisk (*) are required.

I am interested in Practice Management Services offered by Three Rivers AHEC. I have chosen the following topics for your technical assistance:

First Choice: Please choose you first topic Organizational structure Personnel policies Job descriptions Staffing levels and utilization Patient flow and appointment scheduling Provider/staff productivity Operational systems HIPAA gap analysis, compliance plan and staff education Monthly report analysis, utilization, and education Fee schedule analysis and maintenance Accounting procedures Expenditure reviews with suggestions Billing and collection policies with education Internal control systems with policies and procedures Practice demographics Marketing with a plan of action Coding analysis - benchmarking Payor mix Fee schedule and maintenance Internet and data base utilization Medical coding, documentation training and review HIPAA, OSHA and customer service relations Front Office Presentations HIPAA Privacy and Security Evaluation & Management Coding

Other topic not listed above:

Second Choice: Please choose you second topic Organizational structure Personnel policies Job descriptions Staffing levels and utilization Patient flow and appointment scheduling Provider/staff productivity Operational systems HIPAA gap analysis, compliance plan and staff education Monthly report analysis, utilization, and education Fee schedule analysis and maintenance Accounting procedures Expenditure reviews with suggestions Billing and collection policies with education Internal control systems with policies and procedures Practice demographics Marketing with a plan of action Coding analysis - benchmarking Payor mix Fee schedule and maintenance Internet and data base utilization Medical coding, documentation training and review HIPAA, OSHA and customer service relations Front Office Presentations HIPAA Privacy and Security Evaluation & Management Coding

Other topic not listed above:

Third Choice: Please choose you third topic Organizational structure Personnel policies Job descriptions Staffing levels and utilization Patient flow and appointment scheduling Provider/staff productivity Operational systems HIPAA gap analysis, compliance plan and staff education Monthly report analysis, utilization, and education Fee schedule analysis and maintenance Accounting procedures Expenditure reviews with suggestions Billing and collection policies with education Internal control systems with policies and procedures Practice demographics Marketing with a plan of action Coding analysis - benchmarking Payor mix Fee schedule and maintenance Internet and data base utilization Medical coding, documentation training and review HIPAA, OSHA and customer service relations Front Office Presentations HIPAA Privacy and Security Evaluation & Management Coding

Other topic not listed above:

* Practice Name:

* Address 1:

Address 2:

* City:

State: GA

* Zip:

* County:

* Phone:

* Contact Person:

Email:

The best day of the week for my office will be:
Monday  Tuesday  Wednesday  Thursday  Friday

Please provide three dates of your choice:

First choice:

Second choice:

Third choice:

*Physician /owner name:

  

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Web services by SPINEN. Revised: January 12, 2007