CLINIC DISCOVERY QUESTIONNAIRE

Understand the practice before recommending the program.

Use this as a guided conversation—not a form to throw over the wall. The first call should establish fit with aggregate information. Request supporting evidence only after the practice agrees on scope and a secure exchange method.

Request a guided assessment

Two-stage discoveryStage 1: practice, population, payer products, current workflow, goals.Stage 2: contracts, policies, de-identified claims evidence, operating documents.

Do not collect patient-level information during the initial conversation.

Use aggregate counts and de-identified examples. If protected health information is later required for an authorized implementation activity, establish the appropriate agreement, minimum-necessary scope, access controls, and secure transfer method first.

FIRST 15 MINUTES

The minimum screen.

These seven answers determine whether deeper discovery is worthwhile.

What kind of organization and service setting is this?
Which patient population and problem are we trying to address?
How many active patients are in scope, using what definition?
What is the payer mix—and what are the exact top payer products?
Which related programs or codes are already being delivered or billed?
Who owns clinical decisions, operations, billing, technology, and compliance?
What decision must this assessment support, and by when?

FILLABLE DISCOVERY

Record what is known—and what still needs an answer.

Check an item when it has been discussed. Add the answer, evidence source, owner, or open question in the notes field. You can also add a custom item to every section.

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Organization and service setting

Identify who will furnish the service, where it will occur, and which payment rules may apply.

Legal entity, DBA, website, primary contact, decision maker, and clinical sponsorNotes or answer (optional)

Practice type: independent office, multispecialty group, FQHC, RHC, hospital-owned/provider-based clinic, home-based practice, SNF/LTC, rehabilitation/PT/OT, behavioral health, pharmacy, or otherNotes or answer (optional)

Specialties, clinician types, number of rendering clinicians, locations, counties, ZIP codes, NPIs, and TINsNotes or answer (optional)

Common place-of-service codes and whether any location is paid under FQHC PPS, RHC AIR, hospital outpatient, capitation, or another non-standard methodologyA county alone does not determine the payment method.Notes or answer (optional)

ACO, IPA, medical group, MSO, health-system, or delegated-risk affiliationsNotes or answer (optional)

Patient population

Describe the opportunity using aggregate counts—not patient-level information.

Number of active patients and the time period used to define “active”Notes or answer (optional)

Age bands, service area, languages, caregiver availability, transportation, digital access, and preferred communication channelsNotes or answer (optional)

Most common diagnoses and high-need cohorts; include recent discharges, avoidable utilization, behavioral health, social needs, and chronic pain when relevantNotes or answer (optional)

Approximate number who may meet each clinical program’s eligibility requirementsNotes or answer (optional)

Known exclusions or barriers: another billing practitioner, hospice, home health overlap, device/connectivity limits, inability to consent, or poor reachabilityNotes or answer (optional)

Payer mix and exact insurance products

Separate the patient’s payer category from the contract and benefit that actually govern payment.

Patient count or percentage by Original Medicare fee-for-service, Medicare Advantage, Medi-Cal fee-for-service, Medi-Cal managed care, dual eligible/Medi-Medi, commercial, workers’ compensation, self-pay, and otherNotes or answer (optional)

For every major payer: legal payer name, exact plan/product name, line of business, HMO/PPO/EPO type, network status, and approximate covered livesNotes or answer (optional)

For Original Medicare: participating status, Part B billing arrangement, service ZIP/locality, practitioner type, and whether the practice accepts assignmentNotes or answer (optional)

For Medicare Advantage and commercial plans: contracted fee schedule, amendments, medical policy, authorization/referral rules, billing modifiers, place-of-service rules, and provider enrollment statusNotes or answer (optional)

Whether payment is fee-for-service, capitated, delegated, bundled, PMPM, shared-savings, quality-incentive, or a combinationNotes or answer (optional)

Dual/QMB population and the current process used to prevent prohibited balance billingThe patient share shown in a fee schedule is not always collectible.Notes or answer (optional)

Care-management, remote-monitoring, telehealth, device, or value-based payments already included elsewhere in the contractNotes or answer (optional)

Current programs and code use

Find existing services, ownership, and billing conflicts before designing anything new.

Programs currently offered or billed: RPM, RTM, CCM, complex CCM, PCM, APCM, TCM, BHI/CoCM, PIN, CHI, CPM, annual wellness visits, home health, hospice, or related servicesNotes or answer (optional)

Codes billed, monthly claim volume, allowed amount, paid amount, denial rate, adjustment reasons, and payer differencesNotes or answer (optional)

Who is the billing practitioner for each program and how the practice checks whether another practitioner is already billing an incompatible serviceNotes or answer (optional)

Current vendor, contract term, device arrangement, enrollment count, activation rate, and exit termsNotes or answer (optional)

How consent, initiating visits, care plans, device/data-day requirements, interactive time, staff time, and practitioner review are documentedNotes or answer (optional)

Clinical and patient workflow

Map how a patient moves from identification through follow-up and escalation.

How eligible patients are identified, clinically approved, contacted, educated, consented, and enrolledNotes or answer (optional)

Who creates and maintains the care plan; who reviews readings, messages, symptoms, and adherenceNotes or answer (optional)

Provider-approved escalation thresholds, response times, after-hours coverage, emergency instructions, documentation, and closed-loop follow-upNotes or answer (optional)

How discharges, specialist updates, medication changes, missed readings, and patient opt-outs reach the responsible teamNotes or answer (optional)

Patient cost-share explanation, language access, accessibility, complaint handling, and preferred call/text cadenceNotes or answer (optional)

Staffing and operating capacity

Confirm that the proposed workflow has appropriately qualified owners and sustainable coverage.

Available roles, credentials, licenses, FTE capacity, supervision model, and state(s) where patients are locatedNotes or answer (optional)

Who owns outreach, clinical review, care coordination, coding, claims, denials, quality checks, and management reportingNotes or answer (optional)

Hours of coverage, holidays, back-up coverage, turnover, training, and expected patient-to-staff ratiosNotes or answer (optional)

Work that must remain with the practitioner versus work that may be performed by clinical staff or other personnel under the applicable ruleNotes or answer (optional)

Technology, data, and security

Determine whether the workflow can be integrated and audited without unsafe workarounds.

EHR, practice-management system, billing platform, clearinghouse, patient portal, phone/text platform, device platform, and analytics toolsNotes or answer (optional)

Available interfaces: API, FHIR, HL7, secure file exchange, SSO, or manual workflowNotes or answer (optional)

Where eligibility, consent, readings, time, interactions, care plans, escalations, and billing evidence will be storedNotes or answer (optional)

Security review owner, BAA requirements, access controls, audit logs, retention policy, incident-response process, and approved communication channelsNotes or answer (optional)

Revenue cycle and evidence

Test whether services can move from documented work to a clean, defensible claim.

Billing owner, coding review, charge-entry timing, claim edits, clearinghouse rejections, denial workflow, and appeal ownershipNotes or answer (optional)

Baseline clean-claim rate, denial rate and top reasons, days in A/R, net collection rate, underpayment process, and patient-balance workflowNotes or answer (optional)

How eligibility, payer/product, authorization, rendering NPI, place of service, modifiers, date ranges, and code conflicts are validated before billingNotes or answer (optional)

Whether the practice can produce an auditable packet connecting the claim to consent, eligibility, required service elements, time/data thresholds, and practitioner oversightNotes or answer (optional)

Goals, economics, and governance

Define the decision the project must support and the people who can act on it.

Primary goal: access, continuity, outcomes, utilization, workload, patient experience, revenue integrity, or a defined combinationNotes or answer (optional)

Current baseline, target measure, measurement owner, reporting cadence, and acceptable pilot thresholdNotes or answer (optional)

Expected eligible population, realistic enrollment rate, staffing and technology cost, device cost, training burden, and contract constraintsNotes or answer (optional)

Executive sponsor, clinical owner, operations owner, IT/security owner, billing/coding owner, compliance/counsel contact, and final decision makerNotes or answer (optional)

Desired launch timing, pilot size, dependencies, go/no-go date, and reasons the practice would stop or expandNotes or answer (optional)

Supporting information available

Identify what can be reviewed after fit, purpose, security, and a transfer method are agreed.

Aggregate payer-mix report with the reporting period and patient-count definitionNotes or answer (optional)

Top payer/product list and applicable contracts, fee schedules, amendments, and medical policiesNotes or answer (optional)

De-identified claim/ERA examples, denial summary, code-volume report, and underpayment findingsNotes or answer (optional)

Current program rosters and performance summaries in aggregate formNotes or answer (optional)

Workflow diagrams, consent language, care-plan template, escalation policy, and billing checklistNotes or answer (optional)

Technology inventory, interface options, security questionnaire, and required BAA termsNotes or answer (optional)

Staffing roster by role/credential and current capacity assumptionsNotes or answer (optional)

Finished with the discovery questions?Complete the contact details below to send this record to PrimeVital. Partial responses are welcome.

Continue to submission

SUBMIT FOR REVIEW

Send the completed discovery record to PrimeVital.

Partial information is welcome. PrimeVital will use the submission to prepare a more focused first conversation and identify any missing evidence.

FitGreen / yellow / red / unknown

EvidenceConfirmed / stated / not supplied / not applicable

Open itemOwner + due date + decision affected

Full nameOrganizationWork emailPhone (optional)

What is the most important decision or problem? (optional)I confirm that this submission contains no patient names, dates of birth, medical record numbers, diagnoses tied to an identifiable person, or other protected health information.Submitted directly to the PrimeVital team. Do not attach or enter patient-level information.

This questionnaire supports operational discovery. It is not payer authorization, coding, legal, or reimbursement advice. Final workflows should be reviewed against current payer contracts and policies and by the practice’s qualified clinical, coding, compliance, and legal advisers.

DESIGN A PRACTICAL STARTING POINT

Tell us where the workflow is breaking. We’ll show you where to begin.

Choose how to connect

Continue on your phoneScan to open a pre-addressed email draft.Email contact@theprimevital.com