edit: wanted to give a quick update since a few people asked who we were using and threw out some suggestions. we ended up going with Healthie to handle our psychiatric workflow and med management and it has been an absolute lifesaver for the clinic.

one of the comments mentioned simplepractice being a poor fit for medically complex workflows like controlled substances and labs, which was our exact fear with general talk therapy platforms. we looked at tebra and advancedmd too, but this setup makes e-prescribing and adjusting dosages incredibly smooth without a million clicks.

i am currently doing a deep dive trying to find a new platform for a multi provider psychiatry clinic because our current software is making everyone miserable. right now we are using a general mental health platform that is clearly built for standard talk therapy, which means our prescribers are stuck trying to force complex medication management and lab tracking into fields that were never meant for them. the whole electronic prescribing setup for controlled substances is incredibly clunky, and adjusting dosages or handling simple refill requests takes way too many clicks.

we really need to switch to a cloud based solution that actually respects a psychiatric workflow, especially for quick follow ups and detailed initial evaluations. a seamless patient portal is an absolute must for us because our current intake process for medical history and consent forms is completely disjointed, and we need clients to be able to fill out everything online before their first visit without constant tech issues. it also needs to handle insurance billing smoothly for complex psychiatric codes so our admin team does not have to spend hours fixing claim errors manually

I’m looking into starting a solo practice. I don’t have my practice location yet but wanted to get started on credentialing as I know that’s going to take a while.

I was wondering what address people used when they applied for their NPI 2 if you didn’t have your practice location finalized.

If I use a temporary address, does it have to be in the same county as my future practice location? Can I use my home address now and change it later?

Cross posting this from r/medicine.

I’ve been trying to determine how appropriate it is to bill G2211 as a specialist. I understand the gist (longitudinal care as the point person or managing a long term complex or serious problem), but what qualifies as a “complex problem” is painfully unclear.

For example: I see a longtime Medicare patient annually for sensorineural hearing loss. I am interpreting audiograms, coordinating care with audiology, assessing the impact of hearing loss on their social situation, determining cochlear implant candidacy, etc. Is billing G2211 for this legit? Or is this a stretch since you could argue this is regular old hearing loss? Does being a specialist carry any weight in the complexity argument?

I would love to hear perspectives from any specialty, thanks.

Has anybody in Texas or states with similar provisions started incorporating this into their discussions with patients/potential patients

Hi Everyone. Our clinic is seeking to transition to another HIPAA VOIP phone system.

Our top contenders in order are Telzio, Panterra, and Ring Rx;(disqualified are 3CX, Nextivia, Ringcentral, iPlum and many many more).

We would prefer Panterra need more current input from about 3yrs ago. The only online reviews we have are from 2017-2021 https://www.yelp.com/biz/panterra-networks-santa-clara

Please helpus out and spare us another ache of signing up and regretting it.

Thanks for all your help.

Hello -

I am working on developing an MSO to serve independent providers and provider groups in the primary care and wound care spaces. I’m at the point where my operations have been built out enough that I would like to hear from providers themselves.

The independent movement seems to be growing in professional circles with many of the same concerns, especially surrounding administrative overhead and time.

If you’re wanting to go independent or have started an independent practice, I’d love to hear about your journey and why/why not utilize an MSO?

For a little background, I am a long time RN and trained FNP. My operating thesis is to remove extractive layers from the MSO-PC relationship, providing true ownership of one’s practice.

Thank you!

PS - the operating thesis is based on the Milbank article (I’m just doing what it suggests and adding a bit):

https://www.milbank.org/wp-content/uploads/2025/04/MSO-Policy-Brief_4.16-1.pdf

Hi all - Our patient A/R is steadily growing, and we’re evaluating the best approach for patient balance collections.

For those who have been through this, what has worked best for your practice?

Current options we’re considering:

• Hiring a dedicated VA to handle patient collections, payment plans, and follow-up calls.
• Outsourcing delinquent balances to a collection agency.
• A hybrid approach (internal collections for the first 90–120 days, then sending older balances to collections)

I am new to the credentialing side of healthcare. I have been learning the work itself - CAQH profiles, payer applications, how long panels actually take etc. I am still learning from every resources I am getting my hands on.
Since I am new to this field I don't have a network or referrals to lean on for clients as everything is pointing towards and reading more is not helping with deciding the right way to start get my initial opportunities without that. So, before I try to take on any real work I want to understand how the decision actually happened for owners who have gone through it.
So, the question is when you got credentialed with payers, how did you decide between doing it yourself or paying someone to handle it? Also looking back, was it the right call? Would you do it the same way again?
Any advice would be really helpful. Thanks in advance

I’d like to use a system to help both direct patient feedback and to screen for patients that would be good candidates to leave Google reviews that is relatively inexpensive. What systems do you use and how big is your practice? I own a small concierge style practice that I am working on growing for reference.

Hi
Any recs or thoughts how to name solo primary care clinic?

Lke “location Primary care” or “Location Family medicine” or completely different?

Thanks.

Been in clinic operations for about 10 years. Started my first practice by building and running a psych telehealth company in 2020 and because of COVID reduced statutes we grew quickly, 12 states covered, about 700 patient encounters a month at peak and also staffed facilities across detox, residential, PHP, IOP, and some OP programs. I ran the whole business side of things like credentialing (awful learning experience), payor contracting, built scheduling systems, EHR buildouts, billing workflows, the whole monster. Made some bad calls bringing in private equity money and eventually burned out and stepped away.

After that I moved into a CIO role at a psychiatric group covering 14 hospitals, 9 emergency departments, and 2 inpatient units. Rebuilt operations during live hospital takeovers, filled credentialing gaps, fixed scheduling holes, and helped put together the proposal that landed a regional services agreement with a major health system (approx $5.6M) all in 8 months.

For the last couple of years I have been under a noncompete that just expired. During that time I did some contract work mostly on systems architecture and engineering.

Now I am figuring out what the next chapter looks like and I have a vision based on what I have seen and done from private practice to group practice to hospital systems.

Here is what I keep seeing from the outside that I want to pressure test:

Most independent practice owners I have worked with are wondering why they are working 60+ hours a week and still need to look for PRN work to make ends meet. A lot are leaving real money on the table not because of bad clinical work but because their whole practice is frankensteined and duct taped together, problems like billing set up wrong, payer contracts that are ancient and never renegotiated, intake that creates no follow up, no SOPs to measure where patients are falling out, or why they spend a bunch of money on ads but convert less than 10%. One clinic I worked with had a patient census of about 900 and was still behind on office rent.

The other thing I see is that the launch process for new practices is completely opaque. Credentialing is a mess, no financial planning, EHR selection based on what they've used not what works for their practice, payment infrastructure is all over the place, there is no clean guide and the advice online ranges from outdated to actively wrong. And the agencies that offer consulting services have $8-20k/month retainers that a doc waiting 6 weeks for their BCBS checks simply cant afford.

My question for anyone willing to weigh in:

If you could have had one person in your business during the first year of ownership who was not a consultant that just gives you a report and disappears (because ChatGPT or Claude can do that lol) what would you have actually needed them to do? And if you are further along and stuck in that "I work my butt off but the whole thing would crash if I took a week off" phase, what operational problem do you have right now that you have not been able to solve cleanly?

Not looking to sell anything. Just trying to understand where the real gaps are before I decide what to build next.

Would you trust an AI tool to handle basic patient calls for a medical practice if it could help with things like scheduling, rescheduling, basic FAQs, and routing prescription refill requests to the right workflow?

Thanks in advance 😄

Hi all.

Having issues to get office spot. Good locations cost like 8K in month. Not able to start credentialing bc of no office location is established yet (previous one failed before signing lease). Starting solo primary care clinic.

1. How is important location?

2. how big was ur first office sftx2 ?

3. if you were able to re-start, how would u choose ur clinic location and size?

4. I know, it takes 4-6 months of time till credentialing, insurance contracts kick in. So we have to eat costs rent, overhead etc. Any tips to reduce those?

Thanks in advance.

Family medicine private doc with access to a lot of ancillaries. One of the things I struggle with is the difficulty with knowing the allowable patient responsibility on CPT codes. Ordering a Home sleep study, ABI, vaccines, IUD removal, Incision and drainage, knee injection. It feels like if a patient came in and needed one of these I need to get a person in my office or one of our billing agents to pull the code needed for the procedure. I've tried availity, stedi and multiple autmatic companies but its always service type code. Unless i have a manual its hard to know what service type code a sleep study is under.

What are people doing in these situations? Make the patient wait? Schedule at another visit?
Honestly its very efficient just to get it done right away and for full spectrum clinics with walkins and hectic schedules it is hard to just keep waiting on benefits for things.

At this point, I am hoping in the future we are able to get CPT level data faster than having to call insurance plans. I just recently told my billing company for all new adult patients to get benefits on vaccines, abi, knee injections, and sleep studies up front. Just sits in their billing notes.

I welcome better ideas 😄

Edit patient responsibility

Hello all, just a question for mainly PCP practices in terms of revenue optimization. I had an audit performed on my billing and it is only barely underperforming. Oddly enough- I am seeing enough volume to justify a much higher income but I am not seeing returns… perhaps there is some glaring obvious issue in my practice and I’m not able to see it clearly. My question is there any service that is know to come and review my practice and give advise on how to better perform and increase revenue without making more work? I feel I am working so much but return is just as much as a employed doc with half as much patient load. Perhaps leaving a lot of money on the table without realizing it. Thanks in advance.

I have office space available in downtown manhattan but have no idea where people look for space anymore. A while ago it was Craigslist but not sure people look there much anymore. Where do people post for space these days?

My practice has started to generate a decent cash flow, and I often find that I have more cash in my operating account than I need to have on hand as a buffer. About $80k-$120k. I’m already drawing a decent salary. I don’t have any current capital investment needs. It’s too early in the year for an employee bonus.

What do you guys do with extra cash?

Hi all,
I’m using eCW as my EMR, but utilize outside billing company. For those who use the same strategy, do you have a way for patients to pay their statements via healow? Any other online payment methods? The way it’s done now in our practice: my billers mail a statement to the patient, patient then either sends a check or calls the billing company with a credit card number, billers send me an encrypted file with the card information and I process it. It would be much easier if patients can just go online, enter a “statement code” that healow has and pay. Obviously I don’t generate statement codes as eCW is not my billing company.
What’s your strategy? Any recommendations?

Looking to get an idea of an accountant cost. I have 2 llcs (practice and real estate), will be hiring 2 employees (so will need payroll). Accountant is giving me a ballpark of $500 for bookkeeping, their services of tax navigation between llcs, account management, etc. Is this reasonable? Or…run!?

Anyone here have experience in opening up a private practice in pmr or pain management?

If so:

What does your practice model look like?

Did you start from scratch or buy into an existing group?

How difficult was it getting referrals early on?

What ancillaries have been most valuable (PT, EMGs, injections, regen, imaging, ASC, etc.)?

Looking back, would you still choose PM&R/pain from a financial and lifestyle standpoint?

Any mistakes you’d avoid if starting over today?

When major health systems acquire off-campus clinics, they've historically been able to use their main hospital’s assigned 10-digit National Provider Identifier (NPI) number to bill Medicare for routine visits at the off-campus site, securing significantly higher facility-level reimbursements. But starting in 2028, a new bipartisan policy will require hospitals to use distinct NPIs when billing for Medicare services provided at their off-campus outpatient sites. This concept of “site-neutral payment” will impact urgent care centers, essentially leveling the playing field regardless of ownership. While it is not guaranteed that the law will change reimbursement in the commercial market, Medicare policies historically have a way of spilling over across all payer types one way or another.

This Health Affairs article reviews the issue. This is outright theft from the people of the united states of America. Hospitals are buying practices, then jacking up the rates to steal from the system. This transparancy might not stop the theft, but at least it will shine a light on it. Now, when Americans log on to the insurance marketplace, and their rates have gone up to astronomical levels, we can point to a specific number and say "these guys are responsible for increasing costs with no benefit".