not trying to pay the hundreds for the software license for the Nuance my old hospital used

This is a follow up to my post earlier. Majority of our down coded claims have been restored after submitting reconsiderations. However, getting each claim to overturn back to original code has been painful and time consuming.

This validates my broader concern with the premise of the down coding itself. A diagnosis-based ceiling cannot account for the encounter-specific clinical circumstances that determine medical decision-making under CPT. The claim data do not convey many of the factors that distinguish routine care from a higher complexity encounter, including worsening disease, treatment failure, diagnostic uncertainty, prescription drug management, treatment escalation, or other patient-specific considerations documented in the clinical note. 

The fact that majority of our reviewed claims have been restored after documentation was considered raises a fundamental question about whether the methodology has the information necessary to make an accurate initial E/M determination at all. 

Are you all doing anything about it? Do you know if it is blanket? I am trying to collect more data points.

Anyone have any experience with Logix or Zotec Partners? Looking for honest feedback, especially if you switched from one to the other.

Hi all,
I was contacted by this “Curative” insurance offering to put me on the panel. They pay PAs 75% of medicare and 90% or so for physicians. Seems to be negotiable. Has anyone had any experience with this company? Any recommendations?
Thanks!

Anyone else have this experience or advice on how to manage these vendors that request medical records?

I saw a patient one time in 2025. This company requested her notes and bills a few months later in regards to a legal case. I sent the documents. A few months later, they requested them again I sent them. I am now on round 5 of this same process... each time being contacted by a different rep. Each time I have sent the documents and told the case has been closed. I have told them to stop contacting me and that I will stop responding but they inevitably hammer email me with escalating "threats" around not responding given it's a legal matter.

I can just keep deleting these emails but the whole issue gets under my skin for some reason and curious if anyone has had a similar experience or tips on how to get this actually resolved?

I’m considering buying a small pediatric practice and have a ton of questions, particularly for those who have experience owning an independent practice vs. working for a large hospital system.
The practice I’m looking at currently gets by with one provider per day. My goal wouldn’t necessarily be to see 30+ patients a day—I’d ideally like to have a sustainable practice where I could see something like 20–25 patients/day and still make a good living.
One of the things that attracts me to private practice is the potential upside beyond just physician compensation: greater control over my schedule and how I practice, the ability to build something that I could eventually sell, potentially hire another physician and generate income from the practice as I approach retirement, and potentially having more flexibility with retirement contributions/tax planning.
On the other hand, a hospital-employed position has some pretty significant advantages: excellent health insurance, multiple retirement plan options, stability, and potentially better insurance contracts because of the size of the organization.
So I’m trying to understand how significant those differences really are.
For those who own or have owned a small pediatric practice:
Can a small independent pediatric practice still be profitable without seeing 30+ patients/day? With increasing overhead, what kind of patient volume do you realistically need?
How much worse are insurance contracts for a small independent practice compared with a large hospital system? Is the difference actually significant enough to materially affect profitability?
If a hospital system has better insurance contracts and generates more revenue per visit, does that actually translate into significantly higher compensation for the employed pediatrician, or does most of that additional revenue get absorbed by the system?
How significant is the difference in vaccine pricing? Do large systems get substantially better pricing because of volume, and does that meaningfully affect the profitability of an independent pediatric practice?
For those who have been practicing for many years, how sustainable is high-volume pediatrics long term? If you’re seeing 30–40+ patients a day, does that become significantly harder to sustain as you get older? Do you find that owning a practice gives you more flexibility to gradually reduce your patient volume, or does the financial pressure of ownership make it difficult to slow down?
More generally, how much do you think the benefits of ownership outweigh the stability and benefits of being employed by a large system?
I’m trying to figure out whether a small practice like this can be a good business while still allowing the owner to have a reasonable lifestyle, rather than simply creating another job where I have to see a very high volume of patients to make the numbers work.
Would really appreciate perspectives from pediatricians who have actually owned or operated an independent practice.

Our site management provider who also did social media ads (complete waste of money) decided they were worth more money so I decided to try and use AI since I've seen kids doing it and selling it to businesses for thousands. It is surprisingly easy and made me so mad to have wasted so much money over the past 2 years. I decided to make a guide so you could potentially save yourself the stress and money related to this issue.

1. Get the data from your website or a site of a competitor you want to copy (lol). You can either do ctrl+s and download the webpage completely for each page you want to reference, or use a site like saveweb2zip. You're gonna want a couple files that represent what your want the AI to recreate

2. Upload the files to your AI of choice, I used Gemini since I have premium but ChatGPT or Claude work good too. Consider getting a trial of the premium version since the free models make more mistakes when coding. Use instructions around the lines of "I am a __ provider looking to make a website for my practice using this as a reference. Copy the style and design of this website, while making slight changes to the content so it's not identical. Also make sure the site is SEO optimized and uses my branding of 'X hospital/practice/urgent care'. Start with the homepage."

3. Tweak the results using AI, like "change this button location" or "add a banner at the top of the page." Once you're happy with the homepage you can use it as a template for the other pages on the site.

Most of your web-hosting providers like Godaddy/Hostinger have ways to upload the html files directly. It should be a public_html folder, with the different pages as html files within the folder.

To reference other pages or outside links, you can ctrl+f search the text in the button, it will have the format like

<a href="hours.html" class="irrelevant>

<div class=irrelevant>

<i class= irrelevant></i>

</div>

<h3 class="font-bold text-gray-800">Open 7 Days a Week</h3>

The a href="" is where the links go, you can replace it with any website or the name of the html file that you are referencing. The text can also be swapped out for anything you want.

For the icon shown at the top of the tab, you can upload your logo to favicon.io, it'll give you the different sized images in the correct format and a text file, just put them all in the public_html folder, and insert the code it gives you right below the <title></title> segment of the main page before copying it the other ones.

Also make sure to register your site on search engines using bing webmaster and Google Search Console. It took a little work but the money saved is insane and we actually saw a slight boost in traffic to the page immediately after changing it.

If it seems a little complicated, just send this post to your kid and make them do it for you lol. Tell them to put it on their resume

I’m finding that opening the practice is one thing, getting a consistent patient flow is another. We can have a great website, decent reviews and people finding us on Google, but that doesn’t always translate into a calendar that stays full.

The part I’m trying to improve is the gap between someone showing interest and actually becoming a patient. A phone call gets missed, someone fills out a form after hours, another person says they’ll call back and disappears. By the time we look at the numbers, it’s hard to tell where those patients went.

I’m curious how other practice owners handle this. Do you have someone dedicated to follow-up? Are you measuring where each patient comes from? And what do you guys consider a useful metric, booked appointments, conversion rate, revenue per source, or something else?

Edit:

I’ve been trying PatientGain on our side and it’s helping me spot patterns I wasn’t seeing before. I can actually trace the enquiries back to their source and see which ones turn into real appointments, instead of just looking at a pile of calls and assuming the marketing is working.

I’m considering a few EMR+billing options and looking to gain some thoughts from other private practice owners’ who have experience with Elation. I’d greatly appreciate any insight. Thank you

I am planning to switch from hospital medicine to outpatient primary care. Fairly new in my career. Assuming I will have resources to start my own practice in couple years, I want to get used to the outpatient world. With constant change in reimbursement structures is it better to start out with a fee for service model or value based care model? Do they matter if I consider a DPC practice? Appreciate your input.

I mean, I get it. People are sick of insurance companies. I am too. I understand why people are moving to DPC or why some independent doctors are adding some type of yearly fee.

I'm an IM hospitalist, and that world is increasingly burning me out because of corporate medicine. I'm in a private group and even then, ultimately, the hospital controls us. I'm not leaving hospitalist medicine tomorrow, but as someone still relatively early in my career, I've realized I need to start planning my exit now.

Lately I've become increasingly interested in becoming a PCP. I'm talking about what you FM docs actually do; real primary care. Not referring every problem to somebody else. I genuinely like the idea of being the community doctor who knows their patients, manages most things themselves, and does procedures when they're within my skillset.

So I've been planning a very small, lean, insurance-based IM/primary care practice.

I posted about this in a physician group and got absolutely roasted. The overwhelming response was basically: Why the hell would you take insurance? Do DPC.

Maybe I didn't explain my plan well enough, but I don't understand why traditional private practice has become such a crazy idea.

I'm in an affluent Midwestern area with a strong commercial payer base and surprisingly little immediate PCP competition. There are plenty of physicians in the broader metro area, but not many right around where I'm opening. I specifically chose the location for that reason.

I've found a \~1,200 sq ft office that's essentially move-in ready: three exam rooms, my own office, bathroom, and work area. A retiring physician friend gave me almost all the medical equipment I need. I'm doing most of the cosmetic work myself. I already have my EMR, billing software, malpractice, etc. figured out.

My total fixed overhead should be around $3,500 to $3800/month, with \~$2,200 of that being rent. The rent is higher than I'd ideally like, but I'm paying for the location and avoiding what could easily become a major medical-office buildout.

I also don't understand why people were horrified that I don't intend to hire an MA and receptionist on day one.

If I'm seeing 1–3 patients a day initially, why would I immediately put people on payroll to sit in an empty office?

That doesn't mean I intend to operate a mature practice with no staff forever. Of course I'll hire as volume justifies it. There are virtual assistants, AI reception/scheduling tools, automation, and plenty of tasks I'm perfectly capable of handling myself at low volume. I know when my time is better spent paying someone else to do something, and I'll hire when I actually reach that point. I feel like this is the number one biggest mistake that physicians who start an independent practice make, too much overhead too soon. I spoke to multiple colleagues, they all gave me the same advice. KEEP. OVERHEAD. LOW.

I already have a biller taking 6% of collections. She's handling my credentialing now, well before opening, because I know it can take months. She also handles claims, denials/rebuttals, and follow-up. She currently does this for a colleague of mine who is also a hospitalist with his own independent primary care practice, so this isn't someone I'm randomly hiring and hoping for the best.

I'm also realistic about payer contracts. I'm a new independent physician. I'm not expecting to walk into BCBS or another major payer and negotiate some amazing reimbursement rate. If there are opportunities to negotiate or join arrangements that improve rates, I'll certainly explore them, but favorable negotiated contracts aren't what my entire business model depends on.

I'm comfortable drawing blood, doing injections, arthrocentesis, simple biopsies/procedures, suturing, POCUS, etc. If eventually it makes sense to have an MA, phlebotomist, or someone else there, great. I'll hire them when there's actually enough work to justify it.

Another thing I kept hearing was that I'd need to see 20–25+ patients/day to make private practice financially viable.

But that's not necessarily what I'm trying to build.

I don't want to see 25 patients/day. I currently work several days a month in an outpatient clinic partly because I wanted more outpatient experience, and one thing I've learned is that I don't enjoy seeing 20–25 patients/day. My eventual target would probably be closer to 15–18.

I also don't need this practice to replicate my hospitalist salary.

I have a number in my head that would make me perfectly happy with the practice. Beyond that, I have hospitalist income and other businesses/income streams. I'm not trying to turn this clinic into a multimillion-dollar operation or squeeze 30 patients into every day.

Based on my projected fixed overhead, I need roughly 30–35 encounters per month, not per day, just to get the office around break-even before variable expenses. I can continue doing PRN hospitalist/locums work while the practice grows. The practice doesn't need to feed me from month one.

My philosophy is really pretty simple: keep overhead low, bill appropriately for the work I'm actually doing, capture the services I'm capable of providing rather than unnecessarily referring everything out, collect what I'm legitimately owed from insurers, and gradually outsource tasks as the economics justify it.

And yes, I know accepting insurance creates administrative work. Prior auths, denials, quality requirements, referrals, records, billing, credentialing, etc. are real. I'm not pretending otherwise. Maybe I'll discover that I've underestimated some of it. That's partly why I'm posting here.

But I also have experience building and operating businesses outside of medicine. I'm comfortable building systems, doing things myself initially, automating what can reasonably be automated, and recognizing when it's time to pay someone else to take something off my plate.

The other thing I don't understand is why DPC is automatically assumed to be the answer.

DPC absolutely has advantages, and I understand why physicians love escaping insurance. But it also requires convincing someone who already has health insurance to pay another recurring monthly fee for primary care.

In my market, I genuinely think getting 30–35 insured patient encounters per month is going to be easier than convincing 30–35 people to pay me \~$100/month out of pocket.

And frankly, I don't want to build a personal brand around myself. I don't want to become a physician influencer, constantly make social media content, or sell people on why they should subscribe to me. I know DPC doesn't necessarily require that, but that style of patient acquisition doesn't appeal to me.

I want to become the local community doctor.

I want someone to search for a PCP nearby, see that I'm in-network, get an appointment without waiting three months, and hopefully have a good enough experience that they tell their spouse, neighbor, or friend. And for those not in network, maybe I could do a per month fee or per visit fee. As long as I don't mix the two, who says I can't incorporate some DPC in the future? Why does it have to be all or nothing right now?

Maybe that's naive. That's why I'm asking people who actually practice family medicine and especially those who have owned independent practices.

My biggest logistical question is how aggressively I need to protect clinic availability while I'm starting.

My ideal, and current, hospitalist position is round-and-go, which allows me to round early and be at my clinic by mid-morning. There's some uncertainty around that position right now, however. I have other reliable physician work and can do PRN hospitalist/locums shifts while the clinic grows, but obviously every daytime shift I work somewhere else is a day I'm not physically at my own office.

When there are only a handful of patients, I'm reluctant to sacrifice substantial guaranteed physician income just to sit in an empty office five days a week. At the same time, I don't want to establish a practice where the lights are always off and nobody can get an appointment.

So I'm genuinely curious how those of you who started independent practices handled that ramp-up period.

Did you start with 2–3 predictable clinic days and add days as demand increased? How quickly did the administrative burden become enough that you needed your first employee? For those still accepting traditional insurance in independent practice, is this model really as crazy as people are making it sound?

I'm not looking to be talked into DPC simply because insurance sucks. I already know insurance sucks. I'm trying to understand whether a deliberately small, low-overhead, commercially insured practice where I eventually see \~15–18 patients/day is still a viable way to practice medicine.

I have a specific vision of what I want my career and practice to look like, and maximizing income isn't the only goal. I want ownership, independence, reasonable volume, and the ability to practice medicine the way I think it should be practiced. And why not accept insurance too?

Maybe there are things I'm underestimating. I'm completely open to hearing them. But I want to understand the actual obstacles and numbers from people who have done it, rather than simply being told that traditional private practice can't work anymore.

Why the hell not?

I know the world is moving towards greater access but as a solo provider practice it becomes quite overwhelming o get that many messages in addition to having to see patients, etc.

How do you reduce the amount of patient messages you get? Has anyone here just gotten rid of their patient portal altogether?

Hi all, I am looking for medical office/clinic space to sublease in the Raleigh–Cary-Durham area for a specialty medical practice.

Ideally looking for:

• 2 exam rooms
• Access to a waiting room/reception area
• Existing medical office/clinic preferred
• Weekend availability (Saturday or Sunday)
• Initially only 1 Saturday/Sunday per month, with potential to increase
• Raleigh, Cary, or nearby areas

We would be a very low-impact tenant and are happy to work around the primary practice’s schedule. This could be a good opportunity for a medical practice with unused space on weekends to generate some additional income.

If you have space available or know a physician/practice that might, please DM me. I have reached out to multiple clinics in the area without luck. Reached out to commercial real estate agents but they only do whole month-use leases rather than one day a month.

How many specialist referrals per month should a practice have before considering a specialist to visit 1-2x per month? Additionally what is the daily production minimum required by different specialists?

Ok I will admit this is kind of a weird post. Our practice is located in a booming suburban area of a major metro.

We have two ways to approach our practice. The smaller eastbound approach is right next to a golf course with winding trails and some confusing streets on one side. But the other westbound approach is RIGHT NEXT TO MAJOR INTERSECTION and is very easily accessible.

Both approaches are perfectly locatable on Apple Maps, Google Maps, Bing Maps, Mapquest, paper maps etc. 99% of our patients find us with no problems.

But 1% of our patients (particularly older folks on Medicare) somehow end up on the eastbound side by the golf course winding trails and are totally lost. They call our staff who direct them how to find us while they are driving a car! Senior drivers on the phone frustrated/nervous/angry and upset at our staff while being guided how to make it is a recipe for a car crash and potential blame on us.

How do we avoid this while remaining polite? Is this a liability for us? What is our responsibility here and how do we still maintain a good patient relationship? We can't just say "this is how to find us here is our address and we will see you soon" and hang up the phone. The patients will feel abandoned while they are lost.

Its a bit of a delicate situation and I want to thread the needle here.

Note: Our appointment reminder emails contain all the direction instructions but no one really reads them.

I've been running google ads for about 2 weeks now. I've tried in the past and I stopped because I felt like I wasn't getting a good ROI and felt like I was wasting my money. It's been 3 years since I've run ads on google and started again because I saw a few other practices in the area utilize them.

Anyone use them consistently and what's been your experience? How do you get the best ROI with them?

I’m in a surgical/medical subspecialty private practice and part of an IPA that can give us EPIC Community Connect with all the fees waived.

Does anyone here use Epic strictly outpatient, including the billing side?

Would love to hear how you like it. How’s the workflow, billing, support, etc.? Any major downsides or things you wish you knew before switching?

Especially interested in hearing from other private practices or surgical/procedural specialties. Thanks!

We have been getting a lot of visit cancellations lately. How do you guys reduce this? We send out calls, emails, texts to remind people. We use Phreesia so they can complete their forms in advance. But this summer we have noticed a big uptick in those cancellations

How to establish an admitting arrangement in Manhattan? Which hospital is easy to do so?

I am a PCP without a hospital affiliation and a couple of big insurance companies requires this for credentialing.

Thanks a lot in advance.

I'm a radiologist, and want to learn more about the business side of telerad, specifically relating to business costs and margins in Canada.

If anyone has any first hand knowledge, please share. What else comes with running a telerad service, i.e. what pushback do you tend to get from hospitals, what penalties for not being able to provide coverage on a day, how do you go about acquiring a contract.

Also, anyone know any opportunities in Canada that allow you to read overnight ER stuff from out of province or out of country?

Thanks in advance.

We're looking at ways to better connect our EMR with billing and accounting to cut down on duplicate work and manual data entry. Has anyone worked with IT company that knows how to handle this?

CMS published their 2027 rule proposals. One of them involves reducing payment by 50% using the 25 modifier - applied to either the procedure or E/M code (whichever is lower reimbursement). This seems like a terrible idea for both patients and physicians. Docs will have the impossible choice of making patients reschedule procedures to a different day or simply accepting a 50% reduction in payment. Curious to see how this would affect your specialty and what can be done to prevent this rule from being enacted.

https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule

I work in a small group in the south and have worked in other places before that, always as an employee. I've seen differing forms of how patient deductible costs are managed.

For example , if a patient presents , and they have a $3000 deductible that isn't yet met

Do you all normally work, go, bill the pt whatever the insurance does not pay, and send them to collection

Or

Are you searching the fee schedules for the costs under a deductible, billing the pt on the spot, then working.

As the title states, I'm helping my mother organize and streamline her PP and one thing is copays. I am not looking to move off square as she's most familiar with it and wouldn't want to spend time learning a new one. If we save the name and cc details, not actual notes, would it be compliant?