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MedCom USA Provider Transaction Portal Savings Calculator

Thank you for contacting MedCom USA, Inc. and responding to our advertisement.
We would like to show you how you can benefit using the MedCom USA System.
We would like to start out by getting some information from you.

None of the information collected here is distributed to any third parties
Where did you see our ad?

I'd like to get some initial contact information from you.

First name:
Last name:
  area code phone extension
Phone number: ext 

Savings Calculator

Would you like to see an estimate of the money you can possibly save by utilizing the MedCom USA System Portal? Enter your estimated information in the boxes in the yellow columns, and we will automatically compute your estimated savings.

Note: the numbers initially shown are a generic example only and can be replaced by your own estimates

Your numbers Monthly cost
  Current MedCom USA
Monthly Service fee/Lease fee Monthly fee   $
Monthly Service charges     $
How many patients do you check for eligibility per day?    
What percentage of that is Medicaid?      %    
How many patient referrals do you generate per day?    
How many minutes verfication per phone call?    
What is the average hourly wage in your office? $       
How many days per month does your office open?    
BENEFIT VERIFICATION / ELIGIBILITY Sub-Totals
What is your estimated billing cost per claim? * $       
How many claims per month do you bill?    
CLAIM PROCESSING Sub-Totals
How many self-pay patients do you have per month? **    
SELF-PAY STATEMENT BILLING Sub-Totals NO CHARGE
How much does your office bill per month? $       
In average, what percentage will become bad debt?     %    
BAD DEBT Sub-Totals NO CHARGE
Based on the information you provided your monthly costs are currently against a monthly cost from MedCom USA of .
Your annual costs are currently versus an annual estimated cost from MedCom USA of . 		Total Cost Current MedCom USA
Monthly
Annually
Your total savings are as follows: TOTAL SAVINGS
Monthly
Annually
 
If you would like us to e-mail you a copy of the form please provide your email:  

We would like you to learn more about the MedCom USA System. Can we get some additional contact information from you?

Name of Doctor:
Type of Practice:
Fax Number:
E-mail:
Best Time to Call:   HH:MM am / pm
Best Time to meet in person:
 
 

If you would like to learn more about the MedCom USA System you can visit our website at www.medcomusa.com
 Or you can write us at info@medcomusa.com or call us at 1-800-327-6537, 631-273-5551 x 680.
To print this form click here

 
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