LIABILITY WORKSHEET
INSTRUCTIONS:

New Patients - Enter the average number of new patients your practice sees each month
Patient visit average - Enter the average number of times a patient will visit your office for treatment
Average Collections - Enter the average amount of money that is collected from an insurance patient, per visit. This should include all co-payments and insurance payments.
Length of Review - Medicare and Private Insurance carriers can review past claims from 5 to 7 years after they have been paid. Please check the type of carrier to whom you most commonly submit claims.
Percentage of Business - Please enter the percentage of business your practice has with an insurance carrier.

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