Clinical Business Framework

The group discussed the different start and end dates for the school year across different regions. Charu mentioned that school in Texas starts later, around August 19th, and ends before Memorial Day. Florence noted that schools in New York start and end much later, with public schools ending as late as June 26th. The conversation also touched on year-round schooling in places like Arizona, which Charu found appealing for travel opportunities.

Jennie led a reflection session marking Florence's six-month anniversary with the company, during which Florence shared how understanding the business's financial metrics and costs has transformed her approach to managing the practice. Florence explained that she now better allocates expenses and staff resources, having realized she doesn't need additional front desk staff but could benefit from expanding virtual assistant services for calls and document management. She described implementing a new system where VAs review and categorize referrals from the EHR, with the goal of capturing and addressing all incoming patient referrals more effectively.

The team discussed challenges with managing patient information in Athena, particularly around tracking referrals and patient encounters. Charu explained that information disappears unless saved as charts, and demonstrated how to use reports to identify active versus inactive patients, revealing a significant number of patients waiting for insurance approval. The group agreed to implement a process where they will call patients multiple times and document outreach attempts, while also informing referring doctors about unsuccessful contact attempts to maintain communication channels.

The group discussed strategies for managing practice operations and growth over the past six months. Florence shared her approach to implementing bonus structures for staff and balancing patient volume with quality care, while Charu expressed concerns about reaching profitability and the need to hire additional staff. Jennie advised Charu on scheduling efficiency, recommending she establish dedicated administrative time and better organize patient slots to maximize productivity. Vineka reported progress in delegating tasks to staff and improving billing processes, including successful resolution of payer code issues that were causing payment delays.

Vineka expressed concerns about filling her schedule due to legal requirements, evaluator needs, and administrative tasks that require her direct attention. She explained that maintaining some empty slots allows her to handle crucial tasks like prior authorizations, insurance denials, and patient selection, as she focuses on accepting patients who will provide better ROI. Jennie acknowledged Vineka's approach to operational efficiency and noted that clinic management is an ongoing process that continually evolves.

Jennie proposed a new structure for the group meetings, suggesting individual one-on-one strategic sessions followed by two group meetings per month from September to March, with August designated as a break. The group discussed continuing their business development discussions, with Florence expressing enthusiasm about moving forward and Vineka noting she needs to address current burdens before focusing fully on business development. Jennie requested that all members complete surveys to help assess progress against business pillars including financial clarity, service line profitability, and operational efficiency.

Jennie discussed her struggle to transition to half-time clinical status in January, as her partnership has refused to vote on the proposal after seven weeks. She explained that after 20 years in full-time partnership, she wants to reduce her workload and pursue other impact opportunities, while maintaining her $20K monthly passive revenue from APCM (Advanced Primary Care Management). Jennie noted that she needs six out of eight partner votes to approve the transition, and she is considering legal action due to the partnership's stalling tactics and attempts to delay the decision until August.

Jennie led a discussion about billing for chronic care management (CCM) and advanced primary care management (APCM) programs, explaining that specialists can perform CCM while primary care providers can do APCM, with different qualifying conditions and billing requirements. The group discussed challenges with billing for phone calls with family members and patients, with Jennie recommending that providers track non-face-to-face time spent on complex patients and enroll eligible patients in CCM to capture billing for this work. Jennie advised the team to start using Athena's CCM module to document and bill for the time spent coordinating care for patients with multiple chronic conditions, noting that Medicare covers these codes while commercial insurance may not.

Jennie shared details about her recent week-long trip to Hawaii for their anniversary, including a visit to Lanai island. Florence discussed attending her youngest daughter's national dance competition in Jersey, which was the third competition of the year for her daughter who started dancing this year. Florence also mentioned technical issues with EEG and EMG machines that required laptop replacement and vendor troubleshooting.

Florence discussed a potential lease opportunity with a hospital that wants to rent space for a year while building a new office for cardiologists joining their system. The hospital would occupy about three-quarters of Florence's upstairs space, potentially including four exam rooms and one larger unfurnished room for providers' offices. The hospital proposed paying per utilization rather than per square footage, and Florence is considering whether to rent the entire space or just the portion currently needed.

Jennie advised Florence on pricing strategies for leasing space to healthcare tenants, emphasizing the importance of ensuring charges are commensurate with market rates to avoid Stark violations. They discussed considerations around Wi-Fi networks, IT management, and the potential impact on Florence's personal real estate expenses. Jennie recommended preparing multiple pricing scenarios and understanding current costs to make informed decisions about tenant rates and personal charges.

Jennie advised Florence on managing rental numbers and insurance considerations for potentially subleasing space to a medical tenant. They discussed the benefits of running financial projections ahead of time and the importance of understanding insurance requirements for subletting versus separate leasing arrangements. Vineka shared updates about her legal deposition regarding property transfer complications and discussed implementing better revenue tracking and collections processes in her practice, with Jennie providing guidance on managing accounts receivable and collection strategies.

Jennie and Vineka discussed billing processes and challenges with their current biller. Vineka expressed concerns about the reliability of AR reports due to system glitches and shared an incident where their biller missed a scheduled meeting without proper communication. Jennie advised Vineka to implement more structure and boundaries with the biller, suggesting a collaborative approach to introduce industry-standard processes and KPIs. Vineka also mentioned issues with onboarding a new biller onto the Optum system, highlighting the need for better coordination and access management.

Vineka expressed frustration with a team member's performance and professionalism, particularly regarding billing processes and data presentation. Jennie suggested having a transparent conversation about the expected sophistication level of billing processes and inviting the team member to decide if they see themselves as part of the team moving forward. They discussed potentially reframing the focus to include AR (accounts receivable) metrics, which might be more suitable for the team member's skills, and considered whether weekly reviews might be too frequent.

Vineka discussed challenges with her current biller, who is a friend, including issues with professionalism, communication, and accountability. The group explored having a backup plan, with Vineka considering having her current consultant's biller take over some responsibilities. They agreed on the need to implement standardized processes and regular reviews of key performance indicators like days in AR and clean claims rates. Jennie emphasized the importance of having clear expectations and ownership of work, noting that while these conversations might impact their friendship, they are necessary for the business's growth.

Vineka plans to meet with her consultant to discuss implementing a more detailed revenue cycle framework in their weekly meetings, moving beyond just reviewing tracker numbers to address specific data points and process improvements. The consultant has made significant progress over six months, including simplifying insurance payers from 140 to 26, implementing front desk improvements like insurance card organization and ID verification, and reducing denial rates from hundreds to a more manageable number. Jennie suggested celebrating these wins more visibly in meetings, as they represent permanent process improvements that will have lasting benefits.

Florence shared details about a recent family trip to the Caribbean for her daughter's 16th birthday, which cost more than expected despite not being all-inclusive. She discussed the relatively short 3-hour flight from New York to the Bahamas and mentioned returning to work the following Tuesday after the trip. The conversation concluded with both participants discussing their travel experiences and flight upgrade situations.

Florence discussed implementing a new bonus structure for her senior PA based on productivity, setting a benchmark of 885 completed visits over a four-month period. The PA exceeded expectations by completing 927 visits, earning a bonus of $42 (20 times the 42 visits over the benchmark). Jennie advised Florence that once bonus structures are implemented, they set concrete expectations that can be difficult to adjust later, and suggested considering differentials for specific days or adjusting the benchmark based on percentage increases.

Jennie and Florence discussed a performance incentive structure for a physician assistant, with Florence explaining her decision to set a $2,650 annual target based on $26.50 per patient, which represents a 5% increase from the previous year's performance. They analyzed scheduling patterns showing the actual patient volume averages 15-16 patients daily rather than the full 21 patients scheduled, leading to discussions about potential adjustments like double-booking patients or extending hours to meet targets. Jennie recommended creating a tiered incentive system where additional 5% increases would result in higher per-patient bonuses, suggesting a structured three-month review cycle and encouraging collaboration with the PA to identify optimal scheduling adjustments. The conversation concluded with Vineka joining to discuss her own hiring considerations for additional provider coverage, particularly to manage new patient acquisition and reduce burnout while maintaining her specialized TMS and Spravato patient panel.

Vineka expressed concerns about losing high-value patients due to long wait times for new appointments, which are currently scheduled for September or October. She discussed the need to hire additional staff or consider locums to maintain business sustainability, though Jennie questioned whether there would be enough market share for a full-time provider. Vineka indicated she could potentially squeeze in emergency patients but has limited availability due to her current schedule and upcoming deposition.

Vineka discussed her challenges with hiring an independent provider for her practice, expressing a preference for a part-time PA over a nurse practitioner while acknowledging she needs more growth before making significant changes to her systems. Jennie advised Vineka to research market rates for psychiatric mid-level providers by checking job postings on Indeed and potentially consulting MGMA data, suggesting she focus on outpatient settings rather than overnight or call coverage. Vineka revealed that hiring decisions have been delayed due to ongoing divorce proceedings, as the practice's sole provider status is a key point in the legal matter.

Jennie advised Vineka on how to evaluate adding a part-time provider, suggesting she calculate costs, assess revenue potential from 99213 visits, and determine break-even points. They discussed using Vineka's unused office space efficiently and potentially redistributing some of her stable patients to the new provider. Jennie emphasized that Vineka's and the new provider's roles would be distinct, with Vineka focusing on higher acuity patients while the new provider handles chronic stable visits.

Florence shared her experience with hiring and training PAs in her neurology practice, describing her preferred gradual onboarding approach where PAs start part-time and work alongside her before taking on independent patient panels. She explained how she uses a triage system to determine which patients new PAs can handle independently versus those requiring more supervision, particularly for complex cases involving conditions like Parkinson's disease and dementia. Florence recommended that Vineka should consider hiring a mid-level provider given her current wait times of 2-3 months, though noted that legal considerations from her divorce may impact timing.

In this session, Florence and Vineka shared real progress on a theme that's been building all year: getting the right work off your plate and onto the right system or person.

Florence walked through the first week of expanding her offshore VA team to handle live phone calls — 40+ calls triaged in week one alone, with a noticeable drop in front-desk volume. We mapped out next steps for delegating the remaining intake channels (voicemail, fax, email), talked through secure email and PHI handling, and dug into using Claude to turn a quick voice memo into a real, reusable SOP.

Vineka shared a great example of delegation in action: her office manager used Claude to independently draft and deliver a staff performance conversation — without Vineka needing to be the one in the room. We also covered her MA hiring update, an ongoing EMR/clearinghouse onboarding delay worth watching, and brainstormed a few psychiatry-friendly EMR and AI scribe options as she evaluates her current setup.

We closed with a look ahead at July scheduling and a quick pulse-check on what's been most valuable in the program so far.

Topics covered: AI-assisted VA delegation • Secure email/PHI handling • SOP-building with Claude • Staff performance management • MA hiring • Clearinghouse/EMR consolidation • EMR options for psychiatry

Finding Medical Staff Recruitment Challenges Florence discussed her ongoing challenges finding help at work and her experience with a recruiter who provided only one potential candidate, a third-year resident looking to move to New York. Florence decided not to pay for the candidate's travel expenses since she was interviewing multiple locations simultaneously, though she would offer to pay for dinner and transportation once in the city. The conversation ended with Florence sharing a previous experience with a large neurology practice in North Carolina that would fly in candidates for multiple interview rounds when interested. PA Hiring and Supervision Challenges Florence and Jennie discussed a potential new hire's timeline for starting work after completing residency, with Florence noting that the candidate plans to begin next summer. Florence shared her current challenges with managing two PAs, particularly highlighting one PA's lack of confidence in making independent decisions about patient care and referrals. While the newer PA shows good learning retention and has developed solid neuro exam skills, she currently sees about 12 patients daily rather than the target of 15, and sometimes requires excessive supervision. Medical Documentation Workflow Challenges Florence discussed challenges with using dictation software for medical charts, particularly issues with ICD-10 coding and the time required to generate and populate notes in the EMR system. Jennie shared her experience using a scribe feature in ECW that allows copying entire notes into the system, which has been a game-changer for her workflow efficiency. The discussion highlighted the need to balance completing patient orders with finishing documentation, as both tasks require time and proper coding. Scribe Software Management Strategies Jennie shared her strategy for managing charting by completing patient conversations and then pausing the scribe software to input notes for the previous patient before moving to the next one. The group discussed technical aspects of using different scribe platforms like Komir and Nabla Copilot, including how to pause and resume recordings and access the software across multiple devices. Florence raised concerns about billing for phone encounters, and Jennie clarified that while telephone-only visits are no longer billable except for behavioral health, patient-initiated digital e-visits through portals may still be billable. Patient Scheduling and Workflow Optimization Florence discussed challenges with patient scheduling and managing messages, explaining how she has implemented protocols for staff to triage calls and handle routine requests. Jennie advised on optimizing time management and suggested using the "Add Context" feature in their EMR system to efficiently document patient interactions without creating new notes. The discussion also covered strategies for delegating non-revenue generating tasks to staff members and the importance of prioritizing revenue-generating activities while maintaining proper documentation. Medical Documentation and Authorization Challenges The group discussed challenges with medical documentation and prior authorizations. Vineka shared that while regular progress notes are adequate, they need to be modified for prior authorization submissions, and Jennie suggested creating templates or macros in the EMR system to handle specific insurance requirements. Florence described her experience with imaging requests for dementia patients and the challenges of dealing with multiple imaging recommendations from facilities. The discussion concluded with Florence sharing her approach to training new VAs through scenario-based role-playing and recorded training sessions to ensure consistent protocols.

Loan Structure and Banking Arrangements Charu discussed her loan structure and banking arrangements with Jennie. She explained that there are prepayment penalties on her loan if paid off within two years, and the banker had been incorrectly withdrawing funds from the wrong loan account. Charu confirmed that she had allocated $48,000 total for salary (6 months at $8,000 per month) and took $30,000 for personal use, including paying her divorce retainer. She noted encouraging financial progress in April, with $20,000 coming into her U.S. bank account, though she acknowledged uncertainty about her overall financial position. Expense Tracking and Patient Discrepancies Charu discussed challenges with tracking expenses and break-even calculations, expressing interest in using QuickBooks to better understand the breakdown between office supplies and other costs. She noted discrepancies in her patient count between different systems, discovering she has 120 patients aged 65 and over rather than the estimated 200. Charu planned to discuss the patient counting discrepancy with Athena in an upcoming meeting to clarify whether the system only tracks patients with actual encounters. Patient Count and Billing Discrepancies Charu discussed discrepancies in her patient count, explaining that while she has 385 patients in the system, Athena is not counting 115 additional patients who she has seen. She mentioned issues with WellMed credentialing, where she was initially denied due to supposed lack of UnitedHealthcare coverage but later confirmed her coverage status. Charu also identified problems with claims processing, particularly address mismatches that need investigation, and noted that Athena suggested considering a consulting company rather than a billing company to handle the additional work. Billing Service Implementation Priorities Charu discussed a conversation with someone who suggested a consulting service could bridge the gap rather than a full billing service, leading Charu to realize she needs to focus on revenue-generating activities. Charu identified hiring a medical assistant and implementing a billing service as key priorities, while also planning to give her front desk person more confidence and guidance to handle common billing tasks like claim denials. Charu's front desk person had already created a cheat sheet documenting common reasons for claim denials and how to fix them. Task Management and Delegation Progress Charu reported making progress on outstanding notes, with the number increasing from 2 to 50, and discussed challenges in completing them due to time management issues. Jennie suggested using a custom GPT tool to help prioritize and manage the workload more effectively. The conversation also touched on Charu's business challenges, including the need to delegate tasks like billing and QuickBooks, and Natasha briefly joined to share updates about her clinic's financial situation and doctor retention. Concierge Practice Business Valuation Jennie and Natasha discussed the challenges of managing low-revenue patients in a concierge medical practice, noting that while insurance payments are collected, these patients do not contribute significantly to overhead costs. Vineka sought guidance on business valuation methods for an upcoming mediation, with Jennie advising against using EBITDA and explaining the importance of considering fixed assets, liabilities including accrued vacation time, and outstanding debt when calculating business value based on a April 2025 valuation date. The discussion highlighted the need to accurately account for various business liabilities and assets to determine a fair business valuation. Business Mediation Preparation Planning Vineka discussed preparing for an upcoming mediation regarding the valuation of her business, noting she needs to gather information about depreciation schedules and business assets from her accountant. She expressed concerns about being underprepared for the mediation process and mentioned she is working with Claude to make additional calculations. Vineka also raised issues about her lawyer's availability during the mediation, as the junior attorney will only be present part-time rather than throughout the entire process. Practice Valuation Revenue Assessment Jennie explained to Vineka how their formula strips out "blue sky" value when evaluating the practice, meaning they don't account for potential future revenue that might be generated if the practice continues operating. Jennie clarified that since the practice doesn't have recurring revenue models like memberships or value-based care contracts, there's no value attributed to ongoing operations beyond the current patient encounters. Vineka confirmed that their practice doesn't have these types of revenue streams, which supports their position that personal income should be separated from the company valuation. Claude for Practice Valuation Strategy Vineka discussed using Claude to compute valuation numbers for her psychiatric practice, but Jennie and Natasha advised creating a separate, focused project for the valuation rather than mixing it with other business information. They suggested asking Claude to evaluate the practice as a medical facility, consider liquidation value rather than ongoing business value, and anticipate counterarguments from opposing counsel. Natasha also recommended using Claude as a divorce mediator to help understand asset considerations and advocacy strategies. Settlement Offer Expired Negotiations Jennie advised Vineka that the settlement offer had expired after it was declined, and they would need to start negotiations from "real numbers" rather than the previous generous offer. Vineka expressed concern about the significant time and resources being spent on legal proceedings, including canceled clinic days and potential depositions. Jennie explained that EBITDA would not be appropriate for this valuation since the practice doesn't have recurring revenues or revenue-generating employees who could operate independently of Vineka's presence. Business Valuation Mediation Strategy Vineka discussed her upcoming mediation session regarding business valuation in her divorce, with Jennie and Natasha providing advice on how to approach the negotiation. They explained the difference between enterprise goodwill (transferable business value) and personal goodwill (value tied to the practitioner), noting that personal goodwill can sometimes be excluded from equitable distribution in court decisions. The discussion covered how to demonstrate that revenue does not equal profitability by accounting for salaries, overhead costs, and business expenses, with Vineka planning to use market rate salary comparisons and focus on profit rather than revenue in her mediation strategy.

Key Takeaways
G2211 Billing Strategy: A trial is needed to identify payers for the G2211 code, as it's being rejected when billed with therapy codes (e.g., 90833). The goal is to capture the ~$23/claim revenue without disrupting the clean claims rate.

Billing System Overhaul: The practice is consolidating to CHARM+Optum to fix chronic data inaccuracies (AR, missed claims). A custom dashboard is being built to provide the detailed, claim-level tracking the billing team needs.

Staffing Crisis Managed: Two MAs quit unexpectedly, but the cohesive team adapted. The hiring process is now highly selective, using AI screening and consultant EQ checks to protect the strong culture.

Progress Validation: A Q1 2026 AR report will be generated to provide objective data showing the team's significant progress, counteracting the demoralization from reviewing unrecoverable 2025 claims.

Florence shared that her grand opening event went well with approximately 120 people attending, including family and friends. She explained that she started seeing patients before the official grand opening on Sunday to accommodate more people without needing to close her office. Florence mentioned she was waiting for photos from a photographer who attended the event.

Florence discussed her progress on a project involving eight rooms with cabinets and sinks, considering potential uses for a larger room and open space, including renting for physical therapy or hyperbaric oxygen therapy services. She explored the demand for complementary services in her area and shared insights from observing a similar practice in Brooklyn that eventually closed. Florence expressed interest in partnering with an independent physical therapy group, particularly one specializing in vestibular therapy and gait training, and mentioned attending a networking event where she met new chiropractors offering comprehensive services.

Florence discussed her new clinic on Staten Island and the challenges of staffing and managing multiple locations. She explained that she is currently using her existing staff who live nearby, but this arrangement is only manageable for limited hours and may not support full-time operations. Florence considered expanding services like infusion treatments but noted logistical challenges, particularly with IVIG requiring a full-time nurse. She plans to hire additional staff, including front desk personnel, to support expanded hours and potentially open 5 days a week by June.

Florence discussed her recruiting efforts, mentioning a potential contact through a friend who became a program director at a hospital with a new residency program. She also shared plans to reach out to contacts at Downstate and mentioned an opportunity to speak to residents in July. Florence expressed concerns about working with a neurologist colleague due to differences in their medical approaches and the high cost of malpractice coverage for part-time work.

Florence discussed the high cost of malpractice insurance, revealing she pays around $31,000-$32,000 for full-time coverage and $17,000-$18,000 for part-time coverage up to 20 hours per week. She proposed that a potential part-time employee should carry their own malpractice insurance due to the significant cost. Jennie suggested Florence consult with other local practitioners about their malpractice coverage approaches and noted that primary care premiums in Montana are under $10,000, significantly lower than New York rates due to lack of tort reform and limited insurance carrier options.

The team discussed resource availability and scheduling, with Florence indicating she could potentially work two days including Mondays once everyone returns from vacation. Charu provided an update on EFT insurance setup challenges, reporting that Aetna was finally processed and Oscar insurance approval was confirmed after a 6-week wait, though Medicare and Echo insurance processing still required monitoring. Charu expressed concerns about managing practice responsibilities alongside patient care, noting difficulties with completing medical notes due to being pulled away for non-patient tasks.

Charu discussed challenges with her nurse's workload, questioning whether she needs to hire an MA to free up the nurse for more management tasks. Jennie suggested focusing on revenue-generating activities that the RN could handle, such as chronic care management and nurse visits. Charu expressed frustration with frequent interruptions during patient care and suggested establishing clearer communication protocols, including specific times for staff to bring up non-urgent matters.

Charu discussed challenges with task completion and workflow management, noting that incomplete tasks from previous days were causing disruptions and requiring her attention instead of focusing on current priorities. She expressed concerns about the nurse's patient rooming process taking too long, with one recent case taking 45 minutes when only 8-10 minutes were available before the next appointment. Jennie suggested creating a collective process with the team and establishing essential information requirements in the chart to streamline patient preparation, while also recommending that the nurse focus on obtaining basic vitals and medication lists rather than comprehensive histories before the doctor's visit.

Charu and Jennie discussed workflow challenges with their nurse, focusing on time management during patient visits and task prioritization. They agreed that the nurse should focus on patient preparation while the VA handles document tasks like refills, with Charu planning to address these issues directly with the nurse on Wednesday. Jennie suggested asking the nurse about what tasks she feels are prioritized and juggling during clinic days to better understand the current challenges.

Jennie advised Charu to use Claude to create a standard operating procedure (SOP) for chart preparation, suggesting she walk through the process and document steps, templates, and document locations. Charu realized she needs to establish clear processes and priorities for her nurse's tasks, particularly around daily intake preparation, as current ad-hoc approaches are causing delays and workflow issues. As next steps, Charu will meet with her nurse to define must-do items and establish clear priorities, with plans to report back on progress at the next meeting.

Charu discussed challenges with increasing patient volume exposing inefficiencies in current processes, and Jennie suggested focusing on defining repeatable systems to handle growing patient numbers. Vineka sought advice on leveraging AI to streamline the hiring process for a cross-trained MA position, as they are facing significant staffing shortages due to recent departures and medical errors. Jennie recommended using ChatGPT to screen resumes more efficiently before interviews, suggesting this could help identify better candidates faster while reducing time spent on poor candidate fits.

Jennie advised Vineka on improving the resume screening process for hiring medical assistants, suggesting she create specific criteria to filter candidates and potentially use pre-interview questionnaires to better evaluate candidates before interviews. Vineka shared her challenges with finding qualified candidates, noting that out of six recent interviews, none were suitable for a second round. The group discussed training approaches for TMS equipment, with Jennie suggesting Vineka could use monitored training videos and quizzes to ensure staff comprehension, and Vineka mentioned she would explore using Hubstaff for tracking training completion. The team also celebrated Vineka's achievement of winning "Best of Salt Lake".

Insurance Claims Processing Challenges Charu expressed frustration with processing EFTs and handling insurance claims, particularly with United Healthcare and Oscar, despite following provided instructions. Charu mentioned that Athena had reached out with some support but was still experiencing issues, and she was considering hiring a billing company to help with the EFT connections. Insurance EFT Enrollment Challenges Charu discussed ongoing challenges with enrolling insurance providers for electronic funds transfer (EFT), encountering issues with multiple insurance companies including Aetna, Optum, Oscar, and Echo. Despite following detailed instructions from Athena and the insurance providers, Charu faced consistent errors where the entered information did not match records in the systems. Florence suggested creating a case with Athena and verifying information directly with the insurance companies to identify if the issue lies with Athena's system or the insurance providers' records. The team suspected that the insurance companies might still have Charu's information tied to her previous job location, which could be causing the enrollment issues. Insurance Follow-ups and Patient Challenges Charu discussed following up on insurance cases, including one that was created last week and two others that require calling 1-800 numbers. She planned to complete these tasks during a break between end-of-year and graduation parties for her daughter. Charu also expressed frustration about a challenging patient visit where a new patient arrived unprepared for their cognitive assessment appointment, leading to a delayed end time of 6:30 PM despite the scheduled appointment ending at 5:20 PM. Florence shared similar experiences with unprepared patients, particularly those referred for memory loss issues, and described her approach of conducting quick exams and requesting family members attend follow-up visits. Cognitive Assessment Billing Procedures Charu and Florence discussed billing procedures for cognitive assessments, particularly focusing on the AD8 questionnaire for dementia screening. Florence explained that she bills using codes 04 or 05 for memory decline visits and includes the AD8 as part of a comprehensive evaluation. They discussed the limitations of their Athena EMR system, noting that while it contains some screening tools, they prefer using paper forms for certain assessments to enable easier comparison and tracking of patient scores over time. VA Management and Boundaries Discussion Charu discussed her experience managing patient visits and setting boundaries, particularly regarding cognitive testing and medication refills. She shared that her new VA has been working independently for three days after only a week of training, handling patient documents and urgent messages effectively. The discussion concluded with Charu seeking advice on setting up phone access for her VA, with Florence suggesting she could use an existing unused line rather than adding a new extension, and explaining how web-based VoIP systems work for remote VAs. VoIP System and Billing Challenges Charu discussed her challenges with VoIP systems, specifically using GoTo, which is integrated with a problematic 3-year contract that limits her ability to switch to Microsoft Teams. Jennie and Florence provided advice on delegating tasks and learning to focus on core business activities rather than technical details. The conversation also covered billing processes, with Florence sharing her experience of having an office manager learn billing from the ground up by starting with a small number of patients, which Charu noted as a potential approach for her own situation. Business Schedule and Support Challenges Charu discussed challenges with maintaining a consistent work schedule while managing a new business, expressing the need for more structured hours, particularly on weekends. Florence suggested focusing on specific areas of confusion and recommended signing up for revenue coaching to address questions efficiently. They also discussed issues with Athena's customer support and explored the possibility of upgrading to a higher-tier billing package, with Florence advising Charu to consult with their CSM about potential promotions before making any changes. Athena System and Medicare Codes The group discussed challenges with the Athena system, particularly around claim submission delays and testing requirements. Florence shared information about a new Medicare code G3002 for chronic pain management, which requires a 30-minute session using a validated pain rating tool like the Ping scale. The discussion also covered the G2211 code for longitudinal care management, with Jennie explaining that it applies to patients with chronic conditions where the provider benefits from an established patient relationship. Obesity Treatment Partnership Discussion Jennie and Charu discussed CBT codes for obesity treatment, with Jennie confirming they are available in Kajabi under the resource library. Charu explored the possibility of partnering with a pharmacy to provide GLP-1 medications to patients at a lower cost than competitors like Him and Hers and Ro, while also offering educational services. Jennie expressed concerns about compounding pharmacies but acknowledged the potential cost-effectiveness of this model, which would involve charging patients a fee for visits while marking up the medication cost by only 20-30%. Medical Practice Management Strategies The group discussed various aspects of medical practice management, including revenue strategies for GLP-1 prescriptions and med spa services. Jennie shared her experience with implementing AI tools like Comir for medical documentation, noting its ability to format and populate ICD-10 codes in eClinicalWorks. Charu recommended a less expensive alternative called Whisper Flow for dictation.