Nvera · Revenue Cycle Management

Practice Questionnaire

A few details about your practice let us build your free revenue analysis — most teams finish this in about five minutes. Rough numbers are fine; we'll refine everything together.

Fields marked * are required · not sure about a number? Check "Not sure" and move on.

Your Practice Required

Practice name *

Specialty *

Your name *

Email *

Phone *

Number of providers *

Collections — we need at least one of these two *

Current annual collections ($)Not sure

Net collection rate (%)Not sure

Volume & Systems Optional — but helpful

Avg monthly claims per providerNot sure

Average reimbursement per claim ($)Not sure

EMR system

Current billing setup

Place of service

Eligibility process & toolsNot sure

Prior authorization process & toolsNot sure

Performance Numbers Optional — best estimates

Current denial rate (%)Not sure

First-pass clean claim rate (%)Not sure

Days in A/RNot sure

Appeal success rate (%)Not sure

% of claims outside timely filingNot sure

Are you MIPS-eligible?

Current MIPS score (if known)Not sure

Payer mix — slide the levers so the total reaches 100%

Medicare%

Medicaid%

Commercial%

Self-pay%

Not sure about our payer mix

Anything Else Optional

nverarcm.com · Confidential — your answers go directly to the Nvera team

Thank you — we've got it.

Your answers are with the Nvera team. We'll reach out shortly to schedule the review of your free revenue analysis.

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