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6. Practice Billing & Assets
How do your
typically pay you? (Check all that apply.)
Cash
Check
Credit card
Electronic bank transfer
PayPal
Venmo
Other - please specify
Are there insurances for which you submit claims to be paid to you, as an in-network provider?
No
Yes
Which insurances? *
Are there insurances for which you submit claims on behalf of a
to be paid to the
No
Yes
Which insurances? *
Are there patients for whom you provide an insurance-ready receipt (“superbill”) to be used by the
for submission to insurance?
No
Yes
Do you want TheraClosure to send final statements from your EHR to current
? If
owes your practice money, they may pay it as they usually do with payment going to your estate/your accounts. If
do not owe money, this final statement serves as their “superbill.”
No
Yes
Do you have any services with recurring payments that you want TheraClosure to stop? Some can be stopped right away and some we would stop after a required transition period (phone, website).
No
Yes
List the services (including the specific company) you would like us to stop.
Does your practice own any valuable assets (e.g., psychological testing materials, paintings, computer)?*
No
Yes
Do you want us to advise your personal representative in regards to giving away or selling these assets?
If so, specify thoughts here:
Ready to save your changes?
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