Financials
- Business tax returns for at least prior two yrs and a year to date income statement
- Quantity, and collections by cpt code for year to date and the previous 2 or 3 years
- Prior years w-2s, 2 current pay stubs. 1099 income or any outside income along with employment agreements
- Staff w-2s and a description of their role and job functions
- Financial statements (profit & loss statements, balance sheet)
- Collection summary (units, payments, & charges) by CPT code by provider (including modifiers)
- Payer mix (units, payments, and charges) by insurance carrier
- Capitated arrangements – contract, panel size, utilization stats, revenue
Operations
- CVs for MDs and PAs/NPs (MM/YYYY format)
- W-2s and 1099s (MD & non-MD)
- Payroll report for most recent pay period
- Current staff roster (name, title/function, hours per week and hourly date)
- MD employee contracts (either internal or outside agreements)
Risk Management
- Fully completed & signed risk management questionnaire for each MD
- Declaration page (Face sheet)- from all insurance carriers within the last 15 years
- Claims History Report (generated by current and previous insurance carriers)
Real Estate
- Fully executed lease (including all riders or exhibits)
- Certificate of Occupancy
- Current Rent Bill with Name of Payee and TIN
- Floor plan, Included Utilities, and No. exam procedure rooms
