Before you begin completing this form, the person responsible for its completion must call our office (503.723.0200) for specific instructions. With an orthodontic practice? Please use our orthodontic form instead. Thank you!
1. Total Number of New Patient Exams: Each new patient, including emergencies, you have never seen before.
2. Gross Production: Total fees for treatment before subtracting any discounts, adjustments, write-offs, etc.
3. Adjustments: Any ledger entry that increases or decreases a patient or insurance balance (discounts, refunds, write-offs, etc.), other than fees and payments. Please be sure to note whether your Adjustments are a positive (+) or a negative (-) figure.
4. Gross Collections: Total money paid on patient accounts.
5. Number of Days Worked: Number of days each doctor was available to see patients.
1. New Exams
2. Gross Production
3. Any Adjustments
4. Gross Collections
5. Days Worked
Accounts receivable aging at end of most recent month:
**Include 90 days and over & 120 days and over. Please ensure that Aged 0-30, 31-60 and 61 and over (2+3+4) equals the total of all account balances (1).
About the Author
Paul Zuelke is president and founder of Zuelke & Associates, Inc. Mr. Zuelke’s extensive ten year professional background in lending and corporate finance, combined with 20+ years of consulting experience with over 700 client practices located throughout the United States, Canada, and Australia, position him as the leading authority in using effective credit granting and credit management to build a quality health care practice. Read more »
Our Corporate Purpose is to make a fundamental change in the nature of the orthodontic profession by teaching that through risk identification, risk management, and accounts receivable control, our clients will have not only optimum growth, cash flow and profitability, but most importantly, an impeccable quality of life!
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