Medical Billing, Inc.

And What Do We Charge?

Texas Star believes every provider is unique and the needs of each facility is different.
Therefore, we do not quote a set price nor a set plan, across the board for medical
billing. Instead, we consult and evaluate each practice individually. The choice of
services we provide are up to you, our clients. The service charges are customized to
your needs! We strive to abide by the "fair trade" and reasonable rates concept with
optional payment methods. Please complete and submit the following form for an
accurate quote on pricing.

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Price Quote Survey

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1. Please provide the following contact information:

   Name
   Title
   Organization
   Street Address
   Address (cont.)
   City
   State/Province
   Zip/Postal Code
   Country
   Work Phone
   FAX
   E-mail
   URL

2. Average number of claims per week ?

   
   

3. Average dollar amount of each claim ?

   
   

4. What is your biggest billing problem you are currently experiencing ?

   
   

5. How are you currently processing claims?

   Paper Only?
   Electronically?
   Both?
   Outsourcing but not happy?
   
   

6. What percentage of your claims are rejected?

   0%
   1-10%
   11-20%
   21% or more
   
   

7. What percentage of your claims are Medicare?

   
   

8. What percentage of your claims are Medicaid?

   
   

9. What percentage of your claims are Managed Care?

   
   

10. What percentage of your claims are other?

    
    

11. Do you currently have a backlog of claims?

    None
    Some
    More than I would like
    Substantial!
    
    

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Revised: March 27, 2001