A practice management consulting and training firm working for and with physicians since 1985

Forms and Downloads

Save yourself time and money! Access and customize KZA's useful forms, checklists, and other tools to suit your practice's unique needs.

Financial and Reporting
Billing Service Evaluation Checklist
Daily Close Form
Monthly Financial Indicators Form
Billing and Collections Staff Knowledge Assessment Tool
Exit Interview Form
Standard Employment Application
AR and Reimbursement
Prompt Pay Law Information by State
Medicare Carrier Websites by State
Minor Procedure at the Time of Service Language
Sample Progressive Collection Language for Letters and Messages
Surgery Cost Analysis Formatting and Language
Coding and Compliance
2006 Allergen Immunotherapy for Medicare Beneficiaries
Appeal Language for Modifier 59
Hospital Visit Coding Card
Request for Consultation
Sample Identity Theft Prevention Program (Red Flags Rule)
Sample Referring Physician Satisfaction Survey Language
33 Questions to Answer About the Hospital's Offer

KarenZupko & Associates, Inc. • 625 North Michigan Avenue, Suite 2225 • Chicago, Illinois 60611 • 312.642.5616 • FAX: 312.642.5571

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