Proposal Form - Healthcare Inspired

Contact Information

Tell us about the primary point of contact for this engagement.

Full Name *

Title / Role *

Email Address *

Phone Number

Date of Our Call *

HCI Consultant You Spoke With

How did you hear about Healthcare Inspired?

Organization Details

Help us understand your practice or facility so we can align our services to your needs.

Organization / Practice Name *

Organization Type *

Number of Providers

State(s) of Operation *

EHR / Practice Management System

Current Billing / RCM Vendors or Partners Optional

Other Key Decision-Makers Involved

Services of Interest

Select all areas where you'd like HCI's support.

Select all that apply — you can choose multiple services.

Medical Coding

ICD-10, CPT, HCPCS, specialty-specific coding accuracy and optimization.

Medical Billing

Claims submission, denial management, AR follow-up, and collections strategy.

Coding & Billing Audit

Retrospective and prospective chart audits, compliance risk assessments.

Credentialing

Provider enrollment, payer contracting, re-credentialing, and CAQH management.

Compliance

HIPAA, OIG, CMS compliance programs, policies & procedures, risk mitigation.

Revenue Cycle Optimization

End-to-end RCM assessment, KPI benchmarking, workflow redesign, revenue recovery.

Provider & Staff Education

Virtual workshops, coding/documentation training, CME-style sessions, onboarding.

Interim / Fractional Management

Temporary or part-time revenue cycle or compliance leadership support.

Other / Not Sure Yet

Describe your needs below and we'll recommend the right services.

Medical Coding — Additional Details

Specialties requiring coding support

Current coding challenges or concerns

Medical Billing — Additional Details

Average monthly claim volume

Current net collection rate (if known)

Billing-specific challenges

Audit — Additional Details

Type of audit needed

Trigger for audit request

Additional audit context

Credentialing — Additional Details

Number of providers to credential

Credentialing need type

Payers or insurances involved (if known)

Compliance — Additional Details

Compliance program status

Primary compliance area of concern

Additional compliance context

Revenue Cycle — Additional Details

Area of greatest concern

Annual revenue range (approximate)

Revenue cycle challenges or goals

Education — Additional Details

Audience for training

Preferred format

Topics or training goals

Challenges & Goals

Share the problems you're solving and what success looks like for your organization.

What are your biggest current operational challenges? *

What are your primary goals for working with HCI? *

What has been tried previously?

In-house staff changes or restructuring Hired a billing company or vendor Staff training or education programs Software or technology upgrade Previous consultant engagement Nothing tried yet — first time addressing this

Additional context or notes

Timeline & Budget

Help us understand your urgency and investment parameters so we can scope appropriately.

Desired Start Timeline *

Estimated Monthly Budget Range

Preferred engagement model

Ongoing retainer / monthly support One-time project engagement Interim / fractional staffing support Hybrid of project + ongoing Open to recommendations from HCI

Specific deadline or compliance date driving urgency?

How would you prefer to receive the proposal?

Email Virtual meeting Both

Review & Submit

Please confirm your details before submitting. Our team will prepare your proposal within 2–3 business days.

Your information is kept confidential and will only be used by HCI consultants to prepare your proposal.

Thank You!

Your form has been submitted successfully. The HCI team will review your information and deliver a customized proposal within 2–3 business days.

Questions in the meantime? Reach us at
info@healthcareinspiredllc.com

Let’s Build Your Proposal