Summary

Clinic Connectivity and Service Planning Jennie and Charu discussed internet connectivity options for Charu's clinic in Texas, with Charu planning to wait for Google Fiber implementation before making changes to her current wireless setup. Jennie shared details about her clinic's disaster recovery plan involving multiple fiber companies and server infrastructure across three locations. The conversation then shifted to discussing service line analysis and profit/loss statement breakdown, with Jennie offering to provide one-on-one sessions to help Charu understand metrics for making intentional decisions about staffing and new service offerings like advanced primary care management. Insurance 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.

Summary Paris Trip and Work Updates Florence 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 Projections Jennie 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 Discussion Jennie 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 Models The 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 Challenges Jennie 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 Planning Jennie 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 Management Vineka 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.