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Homestead Professional Billing
 Barbara Oliver, CMRS
Adrian, MI 49221
Phone: (877) 259-1313
Fax: (866) 400-8982

Full Name
Title
Practice Name
Practice Address
Address (cont.)
City
State
Zip Code
Contact Name
Contact Phone Number
Contact Email
Practice Specialty
Approximately how many patients do you see per day?
Approximately how many patient's does your practice see weekly?
Approximately how many claims do you file per month?
What is the approximate dollar amount that your practice bills o
What managed care plans are you currently enrolled with?
Do you own your own practice management software?	YesNo
How is your office currently billing?	In-houseOutsourcedBoth
Are you currently filing claims electronically?	YesNoSome, but not all
What are some of the services you would be interested in?
Please list any additional questions or concerns you might have
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