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In 2007, Dr. Amin Mery was an employed allergist in Houston, frustrated with partners who wanted a CT scan ordered on nearly every patient, kids included. A colleague gave him blunt advice: stop complaining or do something about it. So he gave himself two years. He hired a lawyer and a CPA, set up an LLC, learned the business side medical training never covered, and in 2009 opened his own practice in Austin. Today he runs a four-provider, four-location allergy and immunology practice, and he’s building something new on top of it.
Dr. Heather Signorelli talks with Dr. Mery, double board-certified in allergy, asthma and immunology and in internal medicine, about what that plan looked like, what running multiple sites really takes, and how he found a way to enjoy medicine again.
What we cover:
Episode breakdown
00:00 Welcome and Dr. Mery’s background
01:44 Going independent in 2009 and the two-year plan
05:24 Four providers, four locations and what COVID changed
05:55 The hardest part of running multiple sites
07:54 Would he go independent again?
09:02 IPAs, ACOs and joining a national immunology consortium
10:45 Staffing chaos, private equity and new revenue ideas
11:44 The rise in inflammatory conditions after COVID
13:30 What integrative immunology looks like in practice
18:25 How other physicians can learn the model
20:33 Building something new after burnout
22:35 How to reach Dr. Mery
Connect with Dr. Amin Mery
Resources from NatRevMD
If you enjoyed this episode, subscribe, leave a review, and share it with a physician who’s thinking about going independent.
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When Dr. Heather Signorelli picked a 2026 health plan for her family, she could compare deductibles, copays and out-of-pocket maximums in minutes. What she couldn’t see was what happens when someone actually gets sick: what’s covered, what needs prior authorization, and what counts as medically necessary. Prices are public now. The rules that decide whether a claim gets paid are not. In this solo episode, Heather explains where that gap comes from, how it ends up in your practice as denials and delays, and what needs to change.
The Form Shows the Basics, Not the Rules
The standard Summary of Benefits and Coverage only shows costs for a few simple cases, like having a baby or a simple fracture. A breast cancer example was in the original 2011 proposal and was taken out. When Heather ran her own benefits summary through AI, “no benefits if not pre-approved” came up again and again, with nothing saying what approval actually takes.
Who Really Decides What’s Medically Necessary
You make the first medical necessity decision. The payer makes the second one, and theirs is the one that counts. Many plans use proprietary criteria from InterQual or MCG that are only shared on request. One example: a patient with years of worsening arthritis can be denied a shoulder replacement because their last round of PT was more than 12 months ago.
What the Numbers Say
In a 2025 AMA survey, physicians reported about 40 prior authorizations a week, taking roughly 13 hours of physician and staff time. 95% said prior auth delays necessary care, and 26% said it led to a serious adverse event for a patient. Prior auth data is now public for Medicare Advantage, Medicaid managed care and marketplace plans, and it shows something important: few denials get appealed, and many of the ones that are appealed get overturned.
The Fix: Physicians Set the Minimum Standard
Heather makes the case for a physician-defined minimum level of coverage set nationally or by state, not insurer by insurer. Then plans would have to compete on price, quality and outcomes.
The 2027 HMO Shift
Medicare Advantage is moving toward more HMOs and fewer PPOs. That means more referrals required before specialist visits, and more denials when they’re missing.
Three actions before January:
Episode breakdown
00:00 A physician picking a health plan for her family
01:30 What the Summary of Benefits leaves out
03:45 Running a benefits summary through AI
04:50 The conference conversation on utilization management
07:10 Why plans can’t be compared on what really matters
08:45 The case for a minimum standard of coverage
12:00 Who decides what’s medically necessary
13:30 The AMA prior authorization survey
14:15 Proprietary criteria and the shoulder replacement example
16:00 Biomarker mandates and coverage standards in the lab world
19:00 Prior auth data made public for the first time
21:30 Medicare Advantage moves to HMOs in 2027
23:00 Your January checklist
Resources
If this episode helped, subscribe and share it with a practice owner or manager who’s fighting prior auths right now.
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Why does your practice keep solving the same problems over and over?
A claim issue snowballs, a provider gives notice, a patient complaint lands on the owner’s desk. Everyone scrambles, and six weeks later it happens again. Most independent practices don’t have too many meetings. They have the wrong ones, or none at all.
In this episode, Dr. Heather Signorelli shares the five-layer meeting rhythm she has used to lead teams of up to 8,000 people. She scales it down for practices from a team of four to multi-location groups. It draws on Death by Meeting, Traction (EOS) and Scaling Up, and it’s built for healthcare.
You’ll learn:
If 2026 ended with goals you didn’t hit, your meeting structure may be the reason. Start with the huddle, the weekly meeting and one-on-ones, and build from there.
Free resources:
Want help setting up your practice’s meeting rhythm? Email us at [email protected]
Books mentioned: Death by Meeting by Patrick Lencioni, Traction by Gino Wickman, Scaling Up by Verne Harnish
Missed the last episode? It covers how to run one-on-ones and skip-level meetings that develop your team.
If this episode helped, share it with a practice owner or office manager who needs it, and leave us a review. It helps more independent practices find the show.
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You hung your shingle, or you’re thinking about it. Now what? How do you get patients through the door, keep good staff for a decade, and add physicians without the practice falling apart?
Dr. Ram Surendran, M.D., MBA, opened Rochester Primary Care in Michigan in 2003 with three exam rooms, one employee and no patients. His first patient walked in two weeks later. To keep the doors open, he worked urgent cares, ER shifts and medical evals on the side. He practiced solo until 2021. Today the practice has five physicians.
In this episode, Dr. Heather Signorelli talks with Ram about what it actually took, and what independent owners can borrow from his playbook.
You’ll hear:
Free resources for practice owners
Connect with Dr. Ram Surendran on LinkedIn: https://www.linkedin.com/in/ram-surendran-md/
Questions about your billing or your team? Email [email protected] or visit natrevmd.com.
If Ram’s story hit home, leave a review and share it with a physician thinking about going independent.
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You own the practice. You see your team every day. So why are you always the last one to hear about the problem?
Your front desk has been falling behind on eligibility for weeks. One of your providers runs 45 minutes late and patients are starting to complain. Your billing team is sitting on open charts and denials nobody has flagged. Everyone around you knows. You don't, because nobody has a set time and a safe place to tell you.
By the time it reaches your desk, it's a resignation letter, a payer takeback, or a month of lost collections.
In this episode, Dr. Heather Signorelli, co-founder of NatRevMD, walks you through the one meeting that fixes this: the one-on-one. She ran them across a team of roughly 8,000 in corporate healthcare, and she shows you how to make them work in a practice with one office manager or five locations.
What you'll walk away with:
If you're planning a second location, adding a provider, or just tired of finding out about fires after they've spread, start here.
Free resources for practice owners
Books mentioned:
Next episode: the other meeting rhythms that keep your practice aligned as you grow, without burying your team in meetings.
Want Heather's eyes on your numbers or your team structure? Email [email protected] or visit natrevmd.com.
If this one hit home, leave a review and send it to another practice owner who needs to hear it.
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How many AI billing tools have you been pitched in the last few months? If you are like most practice owners, more than any other vendor in years. Some of these tools are very good, and we are piloting one ourselves. But if your billing process is not clean, adding AI on top of it will only break it faster.
In this episode, Dr. Heather Signorelli shares how we are running our own AI pilot alongside our billing team. She also gives you a simple framework to decide where AI belongs in your revenue cycle and how to evaluate any vendor before you sign.
Fix the process first. If eligibility breaks because the right information is not captured at the front desk, a tool will not fix it. Get workflows out of people’s heads and onto paper, with one set of policies, trainings and checklists across every location. Then decide what to automate.
Automate the work, keep the judgment with your people. AI fits high-volume, rules-based, repetitive work where the right answer is known. Complex denials, judgment calls and quality assurance stay with humans.
Run a controlled pilot. Start with one painful process in one or two practices. Check 100% of the AI’s work at the start and track how fast the review time comes down. If your team has to recheck everything forever, that is not automation.
Define success before you start. Know your denial rate, clean claim rate, eligibility issues and claim speed today. Decide what accuracy the tool must hit and who on your team owns the evaluation.
Ask the hard questions. Ask about accuracy on claims like yours, who catches the errors, what the contract says about performance, and what an exit looks like if the vendor is sold.
Where AI fits in billing today:
Your one action this week: if you are evaluating an AI vendor, ask them which of your billing metrics their tool will move, and by how much.
RESOURCES
IN THIS EPISODE
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Most practices don't have a lead problem. They have a follow-up problem.
Dr. Mona Sodhi, DO, co-founder of Super Doc Tech, built her own direct-pay obesity medicine practice from scratch and found herself running ten disconnected tools on top of seeing patients. In this episode, she and Dr. Heather Signorelli talk about why interested patients slip away, why your CEO time matters as much as your clinical time, and what it takes to build a system that turns interest into booked patients.
What we cover:
The Disjointed System
Website in one place, newsletter in another, networking cards lost under a car seat. None of it talks to each other, so you never know what happens after you meet a potential patient. Most people need about seven touches before they decide to book, and one ask is rarely enough.
The Perfectionist Trap
Medical training teaches us we can't afford a mistake. Carry that into marketing and most physicians freeze and do nothing. Business is flexible. Lives are not on the line when you build a business.
Make Time to Be the CEO
Dr. Mona and her co-founder block four hours a week, just the two of them, to work on the business. If it isn't on the calendar, it doesn't happen.
The Leaky Bucket
Calls that never get returned, contact forms that go nowhere, Instagram automations with no follow-up. Heather shares her own experience trying to find a new physician and never hearing back. Speed to lead matters, and plugging the leak is easier than chasing new patients.
A VA Executes. A Thought Partner Builds Revenue.
Why outsourcing marketing tasks is not the same as having someone ask whether each newsletter, automation and CRM step is actually driving revenue.
Three actions this week:
- Put one recurring CEO block on your calendar and protect it like a patient visit.
- Check how every new patient inquiry gets answered today, and how fast.
- Map the follow-up a new patient receives after the first contact. If it ends after one touch, start there.
Episode breakdown:
00:00 Welcome Dr. Mona Sodhi
00:53 From obesity medicine practice to tech company
02:09 Disjointed systems that never talk to each other
05:11 Why running a practice feels so hard for physicians
07:17 How to find time to be the CEO
11:02 Calendar blocking everything
12:28 What practices struggle with most
15:53 Why a VA is not a thought partner
16:33 Heather's unanswered contact form
19:06 A CRM built around revenue
21:43 How to work with Super Doc Tech
Free resources from NatRevMD:
Billing Performance Scorecard: see where your billing stands in 20 minutes
https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-plan
Free Metrics Audit Review: for practices with 2+ red flags
https://eligibility.natrevmd.com/metrics-audit-natrevmd
Connect with Dr. Mona Sodhi and Super Doc Tech:
Website: https://superdoctech.com
Instagram: https://www.instagram.com/superdoctech/
Facebook: https://www.facebook.com/superdoctech/
LinkedIn: https://www.linkedin.com/in/superdoctech/
YouTube: https://www.youtube.com/channel/UCGcVrEsMu7vjjRP5y-iAi9g
Listen to her podcast: Super Doc Stories
Connect with NatRevMD:
https://natrevmd.com
https://www.linkedin.com/company/79500978/
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Last week a bill was introduced in Congress to stop corporate takeovers of physician practices. Some people are calling it reform. Dr. Heather Signorelli read the actual text, and in this episode she walks through what the bill says, what it leaves out, and why she thinks it misses the root cause of what’s squeezing independent practices.
This is not a political episode. It’s a briefing for practice owners, physicians and healthcare executives who want to understand what’s moving before they’re asked for an opinion on it.
What the bill actually does
Practices would have to be majority owned and majority governed by licensed clinicians, including NPs and PAs. Private equity, insurers and for-profit corporations could not own or control a practice. MSOs could still handle billing, payroll and IT, but not hiring, schedules, pay, billing policy or payer contracts. Non-competes, NDAs and non-disparagement clauses would be void for clinicians, except those who own 25% or more of the practice.
The exemption nobody is talking about
The ownership ban exempts hospitals, all of them. By the sponsors’ own numbers, over 80% of physicians are corporately employed, and roughly 60% of them work for hospitals. That means the ownership rule reaches only about 20% of physicians. The non-compete ban and clinical autonomy protections do apply to everyone, which could be a big change for hospital-employed physicians.
Autonomy without a payment rule
The bill says no one can pressure a doctor on time with patients, orders or coding. But a payer still reimburses an office visit built for 15 minutes. The bill protects the 40-minute visit. It doesn’t pay for it.
Where Heather thinks the real problem sits
Low reimbursement, denials, prior auth fights and same-day bundling cuts are what push practices toward volume over patient needs. Ownership structure doesn’t change any of that. She also covers the Texas Attorney General’s action against UnitedHealthcare and how IPAs give independent physicians negotiating leverage, a thread from EP227 with Ben Phillips.
Three takeaways for practice owners
Episode breakdown
00:00 What the bill is and why it caught our attention
01:54 What the bill actually says
04:05 Enforcement, divestiture and the odds it passes
05:30 The Texas AG vs UnitedHealthcare and the pushback on payers
07:28 What the bill doesn’t touch: payment, denials and admin burden
09:48 IPAs and negotiating as a group (EP227 with Ben Phillips)
10:30 The hospital exemption
13:44 Clinical autonomy vs the 15-minute visit
17:21 Fixing payment at the root: coverage tied to standard of care
19:40 Final thoughts
Resources
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Over the last two weeks I have been interviewing candidates, and I asked every one of them the same question: why are you leaving? The top answer was not money, PTO or benefits. It was career growth. In this episode I share what that means for your practice and how we run our own hiring process.
Build a career ladder for every role. Growth does not have to mean management. Front Desk Coordinator I, II and Lead Front Desk give people a next step. The same works for MAs, NPs moving toward partnership, and physicians on a partner track.
Map year one, two and three. Start people where they are, then add skills like eligibility, prior auths and patient workflow so year three still feels challenging. Often those tasks come off your plate or your office manager’s.
Tie raises to responsibility. Instead of an automatic 2% raise every year, attach a small raise to mastering the next level. Culture matters too: trust, autonomy and input keep people.
Give tech-savvy staff a real project. Evaluating AI vendors or automation, or running HIPAA-compliant social media and website updates. Carve out the time so it is real.
Hire in two interviews. We use an Indeed automation, a short VideoAsk screen with four or five questions to see presence and communication style, then the top three meet me and our leadership panel.
Three actions this week:
Episode breakdown:
Free resources:
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Most independent practices sign the payer contract they are handed. One or two doctors alone are not on a health plan's radar, so the rate stays low and the practice works harder to make up the difference.
This week Dr. Heather Signorelli sits down with Ben Phillips, CEO of Nivano Physicians, an independent physician association in Northern California, and host of Healthcare Uncut. Together they break down how small practices build the leverage the big systems already have.
ACOs vs IPAs. ACOs are built to lower the total cost of care, and physicians share in the savings, usually paid the following year. IPAs bring independent doctors together to negotiate managed care contracts as one group, often on a capitated, delegated model.
No IPA in your area? Throw a pizza party. Ben's advice is literal: invite the independent doctors in your community, across specialties, to dinner and ask whether everyone is struggling with the same rates. That conversation is how an IPA starts.
How to judge an IPA. Look at it like any business you would join: its contracts, its stars rating, whether physicians have a real voice, and whether you are a shareholder or just a member.
Brand is leverage. The bigger institution gets better rates because of the patients it brings. A practice that grows its patient base and shows a health plan where it saves money earns a stronger seat at the table.
THE IPA INTERVIEW: QUESTIONS TO ASK BEFORE YOU JOIN
- Contracts: Which payers do you hold, long-standing plans or startups? What are the rates?
- Quality: How many stars do you have? How do you track HEDIS?
- Patients: Can patients get in on time, get follow-up care and a call on lab results?
- Voice: Is my voice as a physician expected, encouraged or dismissed?
- Ownership: Am I a shareholder or just a member?
- Network: Which hospitals and surgery centers do you partner with?
- Community: Are local doctors of every specialty represented?
THREE ACTIONS THIS WEEK
- Pull your current commercial rates and compare them to Medicare for your top codes
- Ask the independent doctors near you whether they belong to an IPA, and which one
- Score your billing on six numbers before your next payer conversation
FREE RESOURCES
Billing Performance Scorecard: six numbers in, green, yellow or red on each, the dollar value of every red, and a one-page 90-day plan.
https://eligibility.natrevmd.com/natrevmd-billing-performance-scorecard-actionable-plan
Two or more reds? Get a free physician-led Metrics Audit Review:
https://eligibility.natrevmd.com/metrics-audit-natrevmd
2027 Revenue Impact Brief: where 2027 changes will hit your revenue.
https://eligibility.natrevmd.com/know-where-2027-will-impact-your-practices-revenue-free-brief-natrevmd
2027 CONFERENCE
Heather and Ben are planning a 2027 conference for independent practices. Send topic ideas to [email protected]
CONNECT WITH BEN
LinkedIn: https://www.linkedin.com/in/bpsf
Healthcare Uncut on YouTube, LinkedIn and Facebook
CONNECT WITH NATREVMD
Website: https://natrevmd.com
LinkedIn: https://www.linkedin.com/company/79500978/
YouTube: https://www.youtube.com/@NatRevMD
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Medical billing tips for healthcare professionals — by healthcare professionals.
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