Clinical Business Framework

Uncluttered Mind, MD
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  • Entrepreneurship
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Replays

  1. Episode 1

    Live Call January 26, 2026: Introduction

    Clinical Business Framework Live Call - January 27 Jennie introduces the peer group @ 13:10 Jennie explained that the purpose of this peer group is to provide a collaborative space for the participants to learn from each other, troubleshoot challenges, and gain a deeper understanding of their independent practices. She emphasized the goal of making data-driven, intentional business decisions rather than relying on gut instinct. Florence's practice overview @ 16:47 Florence shared that she started her solo neurology practice in the midst of the pandemic in 2020, after previously working in a multi-specialty practice for 10 years. She is now looking to expand her practice by hiring additional physicians and growing her service offerings. Vineka's practice overview @ 23:50 Vineka discussed the recent challenges with her psychiatry practice, including issues with her billing and bookkeeping. She is currently going through a valuation process and working to clean up her financial records and processes. Diving into service lines and profitability @ 46:00 Jennie led a discussion on the importance of understanding the profitability of different service lines within the practices, such as procedures, provider visits, and ancillary services. She challenged the participants to select one service line to analyze in depth over the next month. Coding and billing discussion @ 1:07:22 The group discussed the use of the G2211 code for chronic care management, including the appropriate modifiers and billing considerations. Vineka and Florence shared their experiences with this code and other billing-related topics. Next steps and communication @ 1:14:26 Jennie outlined the next steps, including providing a template spreadsheet for the participants to analyze their service lines. She also discussed the preferred communication method, deciding on using a WhatsApp group.

    1 hr

  2. Episode 2

    Office Hours - February 26, 2026: Mastering Financial Visibility in Your Practice

    Clinical Business Framework Office Hours - February 26, 2026 Senior PA Productivity Analysis Florence discussed her analysis of her senior PA's productivity, focusing on patient visits and working days. She noted a decrease in productivity due to the PA taking PTO and being less available. Florence calculated that the PA sees about 12 patients per day, which she considers acceptable given the complexity of their patients. She is working on getting more accurate numbers for expenses related to the PA's salary and benefits. Patient No-Shows and Scheduling Solutions Florence discussed challenges with patient no-shows and scheduling, noting that while her provider has a full panel of 21 patients per week, they often see fewer due to cancellations. She decided to allow the provider to see one new patient per day from the waitlist to better utilize empty slots. Jennie suggested exploring policies around no-shows and rescheduling fees, while Florence shared that their practice currently charges a $25 fee for two no-shows or rescheduling incidents. They also discussed the limitations of online booking platforms like ZocDoc, which Florence found problematic due to high no-show rates and costly per-patient charges. Revenue Tracking System Integration Challenges Vin discussed significant issues with billing and revenue tracking due to disconnected systems between their EHR and clearinghouse, which has made it difficult to generate accurate reports and reconcile financial data. Jennie and Florence shared their experiences with similar challenges, with Jennie noting that even large organizations can face reporting mismatches, while Florence described how she improved patient collections from 80% to 96% by implementing a real-time eligibility checking system. The discussion concluded with Florence explaining how she now pays a flat monthly fee for the eligibility checking service, which also helps generate accurate revenue reports. Superscript System Implementation Review Florence discussed implementing a new system called Superscript for patient check-in and insurance processing, which costs approximately $999 per month and has been operational for about nine months. The system automatically handles insurance eligibility checks and co-payment collections, though there were some initial glitches with Medicare collections in January that required manual review. Florence noted that while the system guarantees 96% accuracy in collections, the remaining 4% requires manual follow-up, and the system's accuracy has improved over time. Improving Billing and Financial Processes The group discussed billing and financial challenges, with Vinika explaining she had engaged an external bookkeeper and consultant to address issues with her EMR systems and billing processes. They discussed her plan to audit her current biller while implementing new systems to improve reporting accuracy. Florence shared her progress in analyzing profitability across different exam rooms and testing procedures, with Jennie advising her to focus first on overhead costs before diving into specific service line profitability.

    1h 7m

  3. Episode 3

    Live Call March 03, 2026: Ownership Under Pressure: Staffing, Pricing, and Legal Realities

    Clinical Business Framework Live Call March 03, 2026Career Transition and Birthday Celebrations Jennie discussed her plans to transition to part-time work, explaining that she is selling her real estate holdings to secure her financial situation before making the change. She expressed that this shift aligns with her desire to pursue a different path, one that offers more autonomy and a new perspective on her career. The group also celebrated Natasha's birthday, with Natasha clarifying that her Facebook birthday was the previous day, while her actual birthday is on the 9th. The conversation included light banter about having "fake" birthdays and the astrological signs of the participants. Office Hours and Meeting Logistics The team discussed scheduling and logistics for upcoming meetings and office hours. They agreed to hold office hours on Mondays at 5 PM EST, with the next sessions scheduled for March 9th, 16th, and 23rd. Jennie confirmed that meeting replays would be available in Kajabi, and the team reviewed access to the platform. They also briefly touched on using a P&L framework for clinical business planning, though the discussion was cut short due to technical issues. Service Line Profitability Insights The group discussed service line profit and loss tracking, with Florence analyzing PA productivity and Vineka working on revenue tracking with CPT codes. Natasha shared details about her concierge medicine practice in DC and Virginia, which she acquired in stages over 15 years, and described their recent price increase implemented 5 months ago to improve profitability. The discussion highlighted the importance of data-driven decision making while acknowledging the challenges of running clinics alongside these analytical efforts. Healthcare Practice Growth Challenges The group discussed challenges in healthcare practices, focusing on recruitment and team dynamics. Natasha shared her experience gradually transitioning patients to new doctors over four years, while Florence described her efforts to hire additional staff, including a new recruiter she recently connected with. Vineka explained her current limitations in expanding her practice due to legal restrictions from her divorce. The conversation highlighted the difficulties of managing practice growth and recruitment in the healthcare sector. Practice Valuation for Divorce Proceeding Vineka discussed the ongoing delay in getting a valuation for her practice, which is crucial for her divorce proceedings. She expressed frustration with the lack of progress and considered setting a deadline for the valuation. Jennie suggested agreeing on a specific date for the valuation, which would allow Vineka to move forward with her plans, including potentially hiring a new provider to increase the practice's value. Florence provided insights on how the valuation might be determined and asked if hiring a new provider would automatically increase the practice's value. Vineka explained her strategy in the divorce case, aiming to minimize the share her ex-husband would receive by arguing that the practice has significant goodwill, which cannot be divided. Business Value and Divorce Challenges Vineka discussed the challenges of proving business value during a divorce proceeding and expressed concerns about hiring new staff while the case is ongoing. Jennie and Natasha shared their experiences with business buyouts, explaining how ownership transfers can be structured. Natasha recommended using Claude's co-work legal tool, which offers valuable insights for a fraction of the cost of a lawyer, to help Vineka navigate her situation. Financial and Cultural Management Challenges Natasha discussed the challenges of implementing financial changes in her medical practice, including increasing prices and managing debt, which led to cultural tensions with some staff members. She expressed concerns about a particular doctor's dissatisfaction and considered how to address his expectations and potential departure. Jennie and Florence shared their experiences with similar situations, offering insights on managing employee expectations and making strategic decisions. Vineka mentioned ongoing legal challenges related to her divorce, highlighting the importance of assertiveness in legal matters. The group agreed on the need for clear communication and strategic planning in managing both financial and human resources.

    1h 11m

  4. Episode 4

    Office Hour March 9, 2026: Closing the Loop: Fixing Gaps in Your Billing and Collections System

    Clinical Business Framework Office Hour March 9, 2026 Legal Case Evaluation Planning Vineka shared updates about her recent birthday trip to San Diego with her stepdaughter and mentioned she had to cut short a 10-day detox due to the trip. She discussed her plans to draft an email to her attorney regarding a case evaluation, using insights from ChatGPT and Claude AI to explore potential benefits of delays in the valuation process. Vineka aims to finalize the email by the end of the day. Billing Process Improvement Discussion Vineka discussed her current billing process, which involves generating CPT codes and HCFA forms through her EHR, then uploading them to a clearinghouse system. She noted that her biller currently only tracks payments and EOBs, not underpayments or missing invoices. Vineka plans to meet with her biller tomorrow to clarify processes and review tracking methods. Jennie identified potential areas for improvement, such as double-checking that all patient encounters are included in billing batches. Billing Process and Tracking Challenges Vineka explained her billing process, which involves her daughter handling TMS and Spravato submissions through a template system, while her office manages monthly billing through a Google Sheet where a VA enters patient data and codes. The office visits are batched monthly, while TMS and Spravato submissions occur 3 times weekly, with Vineka noting that her daughter's meticulous approach results in more invoices but still experiences claim rejections. The team lacks a clear tracking system for revenue collection, making it difficult to determine the clean claims rate and identify missing payments, which Vineka acknowledged as a significant gap in their financial tracking process. Revenue Tracking System Challenges Jennie and Vineka discussed the challenges in tracking and reporting revenue, particularly the difficulty in accurately tracking collected amounts due to delays and incomplete data entry in the EHR system. Vineka explained that while the biller inputs payment information, not all collected amounts are recorded in the EHR, leading to inaccurate AR reports and a lack of transparency about profitable service lines. Jennie emphasized the importance of understanding the outcome of every claim, including whether it was paid, went to patient responsibility, or was rejected, and suggested expressing this information as a percentage. Billing Process Improvement Discussion Jennie and Vineka discussed billing processes and challenges, focusing on claims rates, clean claims, and payment reconciliation. They identified issues with the current manual process, including inaccurate AR reports and the need for better accountability for claim follow-through. Vineka mentioned plans to add billing for additional forms like the PHQ-9 and GAD, and Jennie suggested reconciling payments with invoices using the EMR system. Vineka also noted the need for digitalizing forms to improve efficiency and reach more patients. Payment Reconciliation and Revenue Issues Vineka and Jennie discussed issues with payment reconciliation and revenue capture. They explored the possibility of having Vineka's biller generate reports of EOBs to reconcile with bank statements, focusing on insurer-based payments. Vineka highlighted the problem of expired checks that were not deposited, and Jennie suggested reissuing them. They also discussed the need to ensure proper payment for extended codes, such as 91417, which Vineka stack for 4 hours per bottle visit. Vineka mentioned that while some insurers paid for only one code, appealing led to payment for all codes in some cases. They agreed to conduct a "reconcile" rather than an "audit" to review these issues, with Vineka's consultant already providing reports. Billing Process Streamlining Discussion Vineka discussed streamlining her billing process by implementing a simplified system for entering patient information and tracking claims. She plans to meet with her biller to review the new process and address issues with denied claims. Vineka emphasized the importance of creating a system to prevent errors and improve accountability, while also expressing her desire to support her current biller by providing a clear process to follow. EHR Invoice Tracking Improvements Vineka and Jennie discussed the issue of missing invoices in the EHR system, emphasizing the need for automated reports to track patient encounters without associated claims. Jennie suggested using their EMR system's reports to monitor outstanding claims and reduce AR days by submitting claims more frequently. Vineka acknowledged the need to improve efficiency, aiming to complete billing within 48 hours of finishing notes, and mentioned using AI tools to streamline documentation processes. Medical Billing System Integration Discussion Vineka and Jennie discussed medical billing processes, focusing on integrating systems for TMS and Spravato, addressing rejected claims, and improving overall billing efficiency. Vineka highlighted the need to close loops in billing issues, such as incorrect EOBs and patient responsibility, while Jennie emphasized the importance of attention to detail and understanding insurance patterns. They agreed on the need for regular audits, initially weekly, to monitor the new billing system once established. Vineka also acknowledged the need to generate accurate reports and requested assistance from the new biller to improve data collection and analysis. Claims Audit Process Discussion Jennie and Vineka discussed the claim cycle process, with Vineka explaining that claims take 2-3 weeks to process. They agreed to audit the claims from the first week of February and potentially go back 3 months to identify any missed payments. Vineka suggested dividing the work between two people, with one focusing on the past 3 months and the other on current submissions. They also discussed the varying timely filing windows for different insurance providers, ranging from 60 to 90 days, and the importance of establishing a process for checking and balancing claims to ensure payment. Revenue Process Transparency and Incentives Vineka and Jennie discussed the need for better transparency and strategic decision-making in revenue generation and billing processes. They explored the possibility of implementing a bonus-based system tied to collection rates and clean claims, aiming to incentivize the biller to improve performance. Vineka highlighted the importance of tracking ADHD claims and other revenue-generating activities to ensure proper financial management and strategic planning. Jennie emphasized the value of gathering comprehensive data to make informed decisions and optimize revenue streams. Billing Process Improvement Discussion Vineka discussed issues with billing processes and the need to improve tracking and collection of payments, which Jennie supported. They agreed to focus on refining the billing system and addressing gaps in processes, with a goal of having a new, streamlined system in place by next week. Vineka expressed some frustration with the current biller but decided to give them a full chance to improve before considering a change. Jennie encouraged Vineka to approach the situation with curiosity and to communicate positively with the biller about their capabilities.

    1h 2m

  5. Episode 5

    Office Hour March 16, 2026: Scaling Your Practice: Hiring, Expansion, and Smart Growth Decisions

    Clinical Business Framework Office Hour March 16, 2026 Staten Island Office Expansion Plans Florence discussed her progress on opening a second office location in Staten Island, including ongoing construction of a ramp for handicap access and the need to relocate a gas meter. She plans to hire at least one neurologist by year-end, with the goal of having one physician and one PA in each office, and is exploring options for the large available space including potential subletting or expanding into neuro-preventative care. She noted that despite nearby Sinai University Hospital hiring four neurologists, there is still significant demand for medical services on Staten Island. Second Medical Office Expansion Plans Florence discussed her plans to open a second medical office location on Staten Island, which is closer to her current Brooklyn residence than her first office. She explained that the Staten Island location is becoming more attractive due to rising real estate costs in Brooklyn, offering tax advantages for commuters from New Jersey. Florence shared that she needs to see 12-13 patients to break even, and is considering a salary-based compensation structure rather than RVUs, with plans to review bonus structures after the first year of operation. Medical Professional Salary Expectations Discussion Florence and Jennie discussed salary expectations and revenue metrics for medical professionals. Florence shared that starting salaries in New York City are around $300,000, with higher amounts for those with fellowship training and procedural experience. They explored the financial implications of a 4-day work week, comparing full-time (5 days) and part-time (.8 FTE) compensation structures. Jennie advised Florence to calculate and compare these numbers to ensure they align with market rates and protect her interests, particularly regarding malpractice costs and revenue generation. Neurologist Demand and AI Tools The group discussed market demand for neurologists in Staten Island and Brooklyn, noting limited competition due to few existing neurologists and many being at retirement age. Natasha shared a tool using Claude AI for medical billing modeling, which can help calculate physician salaries and expenses by conversing directly in Excel. Florence expressed interest in improving her Excel skills and noted challenges with finding information quickly in ChatGPT projects. Jennie suggested using the dot dot dot function to extract and organize information more effectively. Healthcare Provider Credentialing Processes The group discussed credentialing processes for new healthcare providers, with Florence explaining that she currently credentials new hires under her group practice while waiting for full credentials. Natasha shared that her organization typically has a 2-month window between contracting and hiring, allowing time for credentialing, with Medicare taking 3-6 months while private insurances are processed within a month. The discussion also covered IPA membership processes, with Florence noting that joining an IPA group could take 2 months due to board meetings, and the group explored ways to optimize timing for new hires to maximize benefits while minimizing costs. Jennie provided guidance on calculating provider expenses, suggesting that benefits typically account for 30% of salary, and recommended using revenue per visit metrics to project annual costs and revenue. AI Tools Discussion and Strategies The group discussed their experiences with AI tools like ChatGPT and Claude, with Natasha sharing how she uses "act as an expert prompt engineer" to get more effective outputs. Vineka noted that Claude performs better than ChatGPT for certain tasks, particularly in critical thinking, while Natasha explained how she uses both tools for strategic planning and other business tasks. The conversation highlighted the importance of learning how to effectively use keyboard shortcuts and prompts to optimize AI interactions, with Natasha emphasizing that proper prompting can significantly improve results. ChatGPT Strategic Planning Experiences Natasha shared her experience of creating a 20-page strategic plan on a plane and using ChatGPT to refine it, ensuring it did not contain sensitive financial data. She discussed using the tool for difficult conversations, receiving critical feedback, and improving her approach by prioritizing interpersonal struggles. Jennie described her use of ChatGPT for financial analysis and planning, emphasizing its ability to process detailed data and provide insights. Florence expressed her journey as a beginner with ChatGPT, highlighting the need for better prompting techniques to optimize its use. Vineka inquired about the differences between using ChatGPT for conversations versus projects, and Jennie explained her preference for using it for document creation and pre-conversation planning. ChatGPT Project Organization Strategies Jennie discussed her approach to organizing information using projects in ChatGPT, explaining how she categorizes clinical and financial data to create reusable frameworks. She demonstrated how she applies this method to evaluate service lines like Prolia and develop models for recruitment and ramp-up periods for different physician career stages. The group discussed strategies for managing chat conversations, including splitting chats into new conversations and adding valuable content to project behaviors, with Jennie warning about the importance of not deleting documents that could reduce the project's memory capacity. Neurologist Recruitment Template Discussion Jennie shared a prompt template with Florence for recruiting a neurologist, explaining it was adapted from her Independent Physician Launchpad project. She demonstrated how to create a new chat within the project and showed Florence how to organize and manage different chat threads. They discussed compensation structures and market data for neurologist recruitment, with Jennie offering to send Florence the prompt via email for reference. Revenue Cycle Dashboard Access Issues Jennie and Florence discussed accessing and sharing a Revenue Cycle Dashboard in Kajabi, which Jennie planned to organize into a resource library for easier access. Florence encountered issues logging into Kajabi and subscribing to calendars, which Jennie helped resolve by confirming the correct email address and subscription settings. Business Planning and Travel Updates Florence shared her upcoming trip to Paris and discussed using the Fork app for restaurant reservations. Jennie recommended using ChatGPT to create a custom business plan and values statement, suggesting Florence use the plane ride to journal and distill her thoughts. Vineka attended a business conference and met with an audit biller to clarify goals and procedures for tracking revenue and insurance claims. Process Optimization and Claim Collection Vineka discussed the need to optimize current processes rather than making significant changes during an evaluation period, emphasizing the importance of understanding existing issues before implementing new systems. Jennie highlighted the potential for increased profitability by improving claim collection and suggested aligning incentives with the billing process to encourage better performance. Florence shared challenges with Medicaid claim syncing and reporting discrepancies, which Jennie advised addressing with the service provider, Athena. The group agreed to continue discussions after Florence returns from a brief trip.

    1h 36m

  6. Episode 6

    Office Hour March 27, 2026: Know Your Numbers: Compensation, Productivity, and Revenue Flow

    Clinical Business Framework Office Hour March 27, 2026Paris Trip and Work UpdatesFlorence shared details about her recent trip to Paris, including visiting family and Disney, and discussed the logistics of the trip. The conversation then shifted to work-related matters, with Jennie asking Florence about reviewing a spreadsheet on provider compensation in neurology. Jennie mentioned sending the spreadsheet to Florence's email, though there was some confusion about whether Vineka had also received it. Medical Practice Financial ProjectionsJennie and Florence discussed financial projections for a medical practice, with Florence clarifying that the target salary for neurologists should be around $300K rather than $500K. Jennie presented a spreadsheet model assuming 18 patients per day at $190 per visit, with overhead costs of $20K monthly per FTE plus $60K for a medical assistant. They discussed how to allocate overhead costs across providers and reviewed the ramp-up period from 14 to 18 patients per day over the first year. Physician Practice Revenue Structure DiscussionJennie and Florence discussed revenue calculations and compensation structures for a physician practice. They reviewed a spreadsheet model showing net revenue per visit of $190 and explored different revenue scenarios, including a 60-40 split between physician and practice compensation. Jennie explained that the practice share of 40% should cover both the practice costs and MA overhead, with the practice keeping 60% of the revenue. They also discussed adjusting overhead percentages based on productivity levels and potentially implementing bonus incentives for higher revenue performance. Medical Practice Compensation ModelsThe discussion focused on compensation structures and partnership models for a medical practice. Jennie and Florence explored various revenue-sharing arrangements, including a 60-40 split model where physicians would receive 40% of profits after covering overhead costs. They discussed implementing a partnership track requiring 3-year tenure and meeting productivity benchmarks. The conversation also covered how to structure compensation for new hires, suggesting a combination of guaranteed salary for the first year followed by productivity-based compensation. They examined how to account for additional revenue streams beyond patient visits, including incident-to-billing for mid-level providers and various testing procedures. The discussion concluded with recommendations to calculate specific overhead numbers and use existing practice metrics as benchmarks for determining appropriate compensation levels. Revenue Cycle Management ChallengesJennie and Vineka discussed challenges with billing processes and revenue cycle management. Vineka expressed frustration about a lack of progress in addressing billing issues, particularly regarding a patient with seven unpaid visits over 1.5 years. Jennie introduced a revenue cycle management tool to help identify fail points in the billing process and proposed using it to analyze current issues systematically. They agreed to review the tool further in an upcoming meeting to address Vineka's concerns about improving active billing processes. Billing Process Improvement PlanningJennie discussed plans to create a spreadsheet to identify and address common fail points in billing processes, with a focus on reconciling claims and ensuring timely filing. Vineka expressed concerns about relying on a VA for reporting and emphasized the need for the VA to independently identify issues rather than being directed. They agreed to review specific service lines, particularly office visits, from recent months to better understand where processes are falling through. Vineka also mentioned challenges with setting a company valuation date due to ongoing legal proceedings, which is impacting decisions about streamlining systems. Project Timeline and VA ManagementVineka discussed the need to set a timeline for a project, emphasizing the importance of not allowing delays to continue indefinitely. Jennie and Florence had a conversation about using virtual assistants (VAs) and AI scribes in medical practices. Jennie advised Florence on managing a new VA, suggesting the use of Loom videos or screen recording for training purposes and emphasizing the importance of a business associates agreement (BAA) for handling patient information.

    1h 14m

  7. Episode 7

    Live Call March 30, 2026 - Mastering the Revenue Cycle

    Clinical Business Framework Live Call March 30, 2026Insurance Coverage and Management Updates Jennie discussed insurance coverage variations across different providers, noting that Humana and United Advantage cover certain services at 100%, while Blue Cross Advantage plans have inconsistent coverage. She mentioned that about 85% of patients are eligible for chronic care management, which requires documentation of time in 20-minute increments. The group welcomed Charu, an internal medicine physician from Austin who recently opened a private practice, and discussed the revenue cycle management process with Vineka, a psychiatrist from Utah. Healthcare Billing Error Prevention Strategies Jennie discussed common error points in healthcare billing processes, highlighting areas such as patient registration, documentation, coding, claim submission, and accounts receivable management. She emphasized the importance of timely filing, claim scrubbing, and preventing denials by identifying patterns and addressing upstream issues. Jennie also stressed the need for effective clinical documentation to mitigate audit risks and the increasing use of AI in down-coding medical claims. The discussion touched on strategies for managing accounts receivable, aiming to keep the majority of claims within a 40-day cycle and improving collection processes for patient responsibility. Billing Process Challenges Discussion Jennie, Charu, and Vineka discussed billing processes and challenges. Charu explained that her practice has a $100 threshold for automatic billing, while Vineka described their use of credit cards on file with some automation issues. Charu shared difficulties with weight management patients who pay cash but receive insurance-related billing links, and mentioned she needs to learn how to run reports and understand KPIs through Athena's system. Jennie emphasized the importance of becoming educated consumers in billing processes and outlined action items including checking insurance eligibility, posting payments daily, and monitoring AR aging on a weekly basis. TMS Treatment Management Discussion Jennie and Vineka discussed tracking and managing TMS (Transcranial Magnetic Stimulation) treatments, including varying insurance authorization periods and the use of a TMS sheet to monitor progress. Vineka explained that while they don't currently use a "buy and bill" model for expensive treatments due to financial risks, they do administer Prolia injections, with Jennie suggesting exploring a different reimbursement code (96401) for antineoplastic agents like Prolia. The conversation concluded with introductions to Florence, an internal medicine physician in Austin who is opening a new practice and joining the group. Healthcare Billing Process Challenges The group discussed challenges with healthcare billing and reimbursement processes, particularly around neurology and psychiatry services in Austin. Charu highlighted difficulties finding neurologists and psychiatrists who accept insurance, while the discussion also covered coding practices and billing procedures. The conversation focused on developing better reporting systems to track claims processing, with Florence and Vineka discussing the need for more detailed tracking of patient encounters and billing outcomes. Jennie advised starting with basic process verification, such as ensuring all patient encounters generate claims, before implementing more complex tracking systems. Claims Processing Improvement Strategies Jennie recommended Vineka focus on high-level claims reporting, asking yes/no questions about claim submission and rejection status, with deeper analysis only for rejected claims to identify patterns in issues like eligibility, timely filing, coding, or clearinghouse errors. Florence shared her experience learning to submit claims promptly rather than waiting for complete documentation, noting that insurance companies sometimes request additional documentation later. Jennie concluded by introducing an accountability measure, suggesting they establish specific action items for the following month to track progress on claims processing improvements. EHR System Challenges Discussion Vineka discussed her progress on coding tasks and enrolling in telehealth, aiming to streamline processes and eventually complete notes on the same day. The group discussed challenges with their current EHR system, Charm, including its limitations in integrating with AI scribes and handling questionnaires like the PHQ-9. Charu suggested exploring Practice Fusion as an alternative, while Florence and Jennie shared their experiences with more expensive EHR systems like Athena. The conversation concluded with Charu reflecting on the need to complete outstanding point-of-care testing tasks, highlighting the challenge of managing and organizing these tasks efficiently. POCT Billing Process Improvements Charu discussed challenges with billing and documentation for POCT A1C tests, noting she needs to implement better processes for coding and tracking these tests. She plans to create templates for POCT and ensure staff members input the correct codes when running tests. Charu also acknowledged being behind on notes due to spending too much time on detailed documentation, and expressed a goal to streamline her note-taking process while maintaining thoroughness. Florence mentioned working on the action checklist, particularly focusing on denial management and revenue cycle processes in Athena. Athena System Implementation Challenges The group discussed challenges with using Athena, particularly its complexity and the need for guidance to navigate its features effectively. Charu and Florence shared experiences about running reports and emphasized the importance of scheduled coaching sessions to learn how to use the system properly. Jennie suggested using templates and order sets in Athena to streamline processes, including for billing CPT codes related to depression and smoking cessation screenings.

    1h 33m

  8. Episode 8

    Office Hour April 6, 2026: Revenue Cycle Optimization, Strategic Billing, and Operational Efficiency

    Clinical Business Framework Office Hour April 6, 2026 Revenue Cycle Management Issues Jennie and the team discussed revenue cycle management issues, with Vineka reporting finding 51 missing items in the billing process, potentially representing $10,000 in missed revenue for one month. Vineka expressed frustration with the billers' initial disorganized approach and emphasized the need to thoroughly investigate all aspects of the revenue cycle beyond just missing invoices. The team discussed implementing multiple reports to track different aspects of the process, including claims status, encounter verification, and payment posting issues, with Vineka advocating for a combination of detailed manual review and streamlined processes. Medical Billing Practices Discussion Jennie and Vineka discussed billing practices for medical encounters, focusing on consultation codes and telehealth billing. Vineka shared her experience billing a phone consultation with an oncologist regarding a patient's Spravato treatment, which Jennie confirmed was appropriate given the medical complexity and coordination of care involved. They also discussed the benefits of using chronic care management codes for billing time spent on medical decision-making, with Vineka noting she would bill an additional visit when seeing the patient the following day. Practice Repairs and Revenue Concerns Charu discussed completing repairs from water damage, including floor replacement and paint touch-ups, and plans to move exam tables with help from her contractor. She expressed concerns about her revenue, noting that approximately 30% of her billed amount is taken for contracted rates, leaving her uncertain about her actual take after electronic fund transfers. Charu mentioned an upcoming revenue coaching call with Athena and noted progress with her front desk person regarding transitioning her practice to a new location with WellMed, a Medicare Advantage provider. Medical Reconciliation Compensation Discussion Jennie and Charu discussed compensation benchmarks for medical reconciliation work, with Jennie suggesting $50-$100 annually as reasonable compensation since Charu wouldn't be taking on risk or participating in upside. They explored potential companies offering similar services, including Main Street Rural and Vatica, though Charu was unaware of these options in her area. The conversation concluded with Charu discussing her upcoming grand opening ceremony and plans to install sliders under exam tables to make them more movable. Flood Furniture Moving Challenges Charu discussed the challenges of moving heavy furniture after a flood, expressing concern about potential back injuries and considering hiring movers instead of doing it herself. Jennie advised Charu to include the time spent coordinating water mitigation and reconstruction in her insurance claim, suggesting she could bill for a 2-hour minimum move at $200. Charu agreed to contact a mover for assistance and to properly document all expenses for her insurance claim. CEO and Clinical Work Balance Charu discussed challenges with managing her CEO responsibilities alongside her clinical work, particularly around prioritization and time management. She explained her strategy of working in different buckets to avoid getting stuck on unproductive tasks, and emphasized the importance of focusing on the toughest priority items first. Jennie asked about prioritizing revenue-generating activities, to which Charu confirmed she is focusing on completing notes and EFTs to ensure timely payment. Clinical Task Management Strategies Charu and Jennie discussed strategies for managing clinical and business tasks. Jennie shared her approach of designating specific days for clinic work and using personal planning tools like agendas and chat lists to prioritize tasks and reduce resistance. Charu expressed interest in using AI tools to automate tasks and create to-do lists, particularly for managing bills and reminders, as she is still working on automating payments. AI Productivity Tools Discussion Jennie discussed her daily task management using Google Calendar and mentioned experimenting with AI tools like Claude for creating documents and managing tasks. Charu expressed interest in learning more about using AI for productivity, particularly after seeing Jennie's successful use of Claude to create branded handouts. Jennie shared her experience using Claude to efficiently handle document creation that would have otherwise taken significant time with a VA. The conversation also touched on various AI conferences and training opportunities, though no specific decisions or next steps were established. AI Database Tool for Medical Practices Jennie demonstrated how she used Claude to create a comprehensive database tool for medical practices, spending several hours developing it over the weekend. She encouraged Charu to use the same approach to analyze her proforma data by uploading it as a file to a Claude project, which would provide insights and comparisons to industry averages. Charu expressed relief at this practical application, having been concerned about the time investment required, and Jennie emphasized that AI should be used to streamline tasks rather than replace human expertise. Medical Chart Completion Challenges Florence discussed challenges with completing medical charts due to travel commitments and administrative tasks, expressing frustration about not being able to fully utilize her designated non-clinical admin day. She explained that her detailed notes, including required macros for authorizations and imaging studies, make chart completion time-consuming, even with AI scribe assistance. Jennie inquired about Florence's use of AI scribe, particularly with non-English speaking patients, and Florence noted that while Spanish works well, the system struggles with Chinese dialects. AI Medical Documentation Challenges Florence and Jennie discussed challenges with using AI tools for medical documentation, particularly with capturing complete patient notes efficiently. Florence identified that while the HPI section works well, the AMP (assessment and plan) section requires more editing and often gets completed after patient departure. Jennie suggested Florence try doing a "brain dump" with patients before leaving the room to capture the assessment and plan information. They also discussed delegating non-revenue generating tasks to focus on higher-value activities using the 80-20 rule principle. Florence mentioned plans to attend a networking event with local private practice physicians to build referral relationships, particularly with solo practitioners. Revenue Cycle Management Strategies The team discussed revenue cycle management challenges and strategies. Florence plans to analyze service line data with her second PA to determine average values for different tests like EMG and EEG, while also reviewing denial reporting patterns. Charu focused on adding new billing codes to her fee schedule and establishing better systems for completing patient notes within 24 hours. Vineka wanted to review Spravato visit captures and billing. Jennie offered to help Charu review virtual assistant resumes and mentioned she's developing tools for EMG/EEG and Spravato service lines. The group agreed to meet next on Thursday evening at 5 PM PST.

    1h 29m
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