r/PrivatePracticeDocs

I have a few patients with a high deductible insurance. Often they get hit with $150-170 bill they are responsible for. Not a good business practice, but I feel bad. I understand some will say “it’s patient’s responsibility to know this and pay.” Still doesn’t change that I feel a big uneasy. So, make me feel better about sending them tgat bill (granted, it’s sent by my billing company) and let me know how you approach this? Fo you ask patients to pay a partial upfront payment?
Thanks!

Just wondering about this as a hypothetical. At a very basic level, geriatrics is one of the most in demand specialties. At the same time, they are paradoxically among the lowest compensated. What is stopping a high end DPC and/or concierge geriatric practice model from taking hold of more of the market, especially in areas with lots of higher-income seniors? (Eg Phoenix, Ft Lauderdale, etc)

I know the economics of healthcare in this country are wayyy more complicated than simple supply and demand, but I wonder what factors/forces are really keeping this kind of thing at bay.

I am so extremely frustrated and honestly feel defeated. I used to genuinely love my job, but insurance companies are sucking the life out of me.

I have 5 surgical cases where I worked incredibly hard to obtain both GAP exceptions and single case agreements BEFORE surgery. Everything was approved and negotiated in advance.

Then I bill the claims with the authorization numbers attached… and every single one gets processed under MultiPlan rates instead. Completely ignoring the GAP and SCA agreements.

So I disputed the claims through Availity. Of course, Availity categorizes them as “reconsiderations.” I submitted copies of the authorizations and signed SCAs for all 5 cases back in March. Since then, they have all just sat there in “processing” status for months.

Today they finally updated to “finalized.” No notes. No letters. No explanation. Nothing.

I call Aetna and the representative tells me there are “no notes” on the cases, but somehow they were supposedly finalized back in March. Meanwhile, Availity clearly shows the status updated TODAY (5/8).

Then I’m told I only have 60 days from the date “they made their decision” to appeal. What decision?! There are no notes, no determination letter, no communication, and no visible outcome attached to these reconsiderations.

Even the representative agreed it felt intentional and admitted it made no sense that cases would be closed without explanation or provider notification.

At this point it honestly feels like they delay these cases on purpose so providers lose their appeal rights and IDR rights.

I’m exhausted.

Hey everyone,

First off thanks for everyone who is a part of this subreddit. I really appreciate all of you and all the feedback that you all give me. I am doing my best to foster an environment where we can talk about everything private practice related.

We just hit nearly 6,000 members. That's incredible, and it's a testament to how many of you are serious about building and growing sustainable private practices. Thank you.

As the community grows, so does the noise. I've made some rule updates to keep this space high quality and actually useful for people in the trenches.

❌ Problems that I have noticed since last rule update:

➡️ I will admit that IMO, astroturfing and shilling is this subs biggest problem. This is an anon website, and as such part of the limitation is that ANYONE can join. This leads to many companies who almost daily trying to shill or astroturf their company on this subreddit. Please flag those users or members if you see these types of posts or accounts. I will be banning any account that is shilling or astroturfing on here. I have to ban about 10 accounts a week for this problem.

➡️ Along with that is a new problem. Some billing companies, RPM companies / or other businesses targeting medical professionals are creating their own subreddit and attempting to post low effort posts to their subreddit and cross posting to this subreddit to build engagement to their subreddit for their business. I view this as a hidden form of astroturfing personally. It is a smart way to try to circumvent the no shilling or astroturfing rule directly in this subreddit and I salute you for being crafty to try to get around the rule. However, that comes to an end today.

➡️Growth for posting and expert advice. A few of you have reached out to me to do an AMA for this subreddit. I have approved only one person so far to do the AMA in the coming future as of the time of me making this post. I get paid nothing from this person to do the AMA and have no conflict of interest to disclose with this person. I get paid nothing for modding this subreddit. The one AMA that I approved is someone who claims to be an expert at filing and hopefully winning IDR cases. I am not an expert in IDR and since we have quite a few surgeons on here, I figured it would maybe be helpful for them.

I will be listening to feedback from you all to see if you want more of these or less of these. I have put some criteria for this person. They need to publicly try to answer every question they can within reason so that every response is not (click my link to learn more). The responses need to be helpful, and they need to disclose their name and conflict of interest somewhere in their post.

I'm happy to listen to feedback on if the community wants more or less of these AMAs.

If someone wants to do an AMA, for now you can message the mod (me) and I will consider whatever the topic you want to talk about. The purpose of the AMA is to teach on the subject, not to just shill your company or recruit people to join your website / business / etc.

Other quick automatic updates:

➡️ I set up an automod. It was a bit overzealous flagging comments and I have been paring it back from flagging so many comments. I will continue to tweak the automod based on frequency of rule breaking behavior.

➡️ There is a karma threshold to now post here. Almost 100% of the time when I have to take mod action on accounts, it is for accounts with < 50 karma. I have set the threshold at 30 karma to participate in this subreddit and will adjust as needed.

Here's what else is changing:

🚫 No more cross-posts All cross-posts from other subreddits are now automatically removed because of the shilling problem.

🚫 No subreddit funneling I've been seeing low-effort posts designed to drive traffic to other subreddits. This community isn't a launchpad for someone else's audience for their business. Posts like this will be removed automatically by an automod. Repeated offenders will be banned.

🔍 Astroturfing & shilling will be auto flagged If your post reads like a soft pitch "stumbled upon this," "not affiliated but," "game changer for me" well, it's going in the mod queue. You may have seen some automod pending approval from comments. I will keep refining triggering words or expressions that I see commonly used in astroturfing or shilling. Genuine experiences are welcome. Disguised ads are not.

What we want more of:

• Real questions from people building practices
• Honest wins and lessons learned
• Pushback, debate, and experience-based advice
• Support (venting about a tough business event)
• Anything that goes along with starting, scaling, or running a private practice in any specialty of healthcare

Thanks for everything everyone, and as always I'm open to feedback on what you want me to change, see more of, or less of. Have a great day!

I've been a long time lurker here and I finally got around to starting my own practice two months ago. My tech stack and systems are decent. However, I'm running into a very fundamental issue - I'm not getting enough patients. I know two months is nothing, but the sheer lack of volume is terrifying and I need some advice.

I'm running a self-pay telehealth weight loss clinic, licensed in two states. Boarded in internal and obesity medicine. I know the space is competitive, but I know exactly who my target audience is and I've built a differentiated product around serving them. I haven't credentialed with insurance - they are controlling and restrictive and I want to serve my patients without the headaches they bring.

I've been active and posting on all the socials and have a Google business profile, but I've gotten no organic hits. I've managed to recruit a few patients from Klarity (it's kind of like ZocDoc) but their UI is very frustrating and they have exorbitant fees. Otherwise, it's just been a few people via word of mouth. I've reached out to a couple doctors offices asking for referrals but they've kinda snubbed me so far.

I need honest feedback - need to know what other people who've ran a cash business or DPC have done to get patients in. I'm considering running ads, but they might be money burn. Should I be reaching out to more doctor's offices? Posting more on social? Or do I need to pivot my strategy, such as accepting insurance or opening up an office?

Any advice would be great.

Hi there! My Dad has a private Podiatry practice in a small town outside of Kalispell, MT. He is ready to start planning for retirement and wants bring on an associate with the plan to have them take over the practice after x amount of years. It’s a gorgeous town and outdoor activities galore. My dad skis all winter long and has a great work/life balance on top of managing his hobby ranch.

His bread and butter is specializing in surgical procedures and wants to share his abundant knowledge. There’s lots of work is this area, he has to turn down a good amount of patient inquiries.

He’s older and not super versed in how to spread the world of this opportunity and was curious if anyone had recommendations on where to post this type of opportunity. If you have any ideas to share I’m all ears.

Lastly, is there anything he should be aware of regarding pay, the smaller town location, etc.

I live in the tech space and know I probably botched the technical wording across the board, just trying to help my Dad get aligned on posting resources, expectations, so he can start planning his retirement and being able to share his immense knowledge of surgical abilities.

My friend wanted physical therapy and called like 20 places today. Many had 3-4 month wait which seemed crazy to me. She did manage to book an appointment for tomorrow after hours on the phone, but she also said she would’ve been happy to get on a “wait list” to get a text/ call in case any space opens up. But none of the places offer this as an option.

This makes sense to me from the patient’s perspective and would solve no show, but I wonder why this is not implemented on the provider’s side? Is there something I’m missing here?

Recently attended a talk where the speaker pointed out that the average 55yo today will be receiving almost 7x the amount from Medicare that they paid in Medicare taxes throughout their career. Given that legislators in Washington simultaneously promise Medicare to their voters forever yet are never gonna be caught trying to raise taxes, it seems like the only solution will be to continue the slow and steady decrease in reimbursements paid out to physicians. And given that Medicare reimbursements are a major anchoring point for other payors, the problem will be across the board.

At what point will a DPC style practice be the only viable option for a doc who wants to see a reasonable amount of patients and still get paid what they’re worth? Or will most docs just keep trying to spread themselves thinner by expanding with more mid levels, shorter appointments, etc

Happy Wednesday everyone. Figured I would post a little light humor for all of us who struggled with finding good talent to hire. You are not alone.

I have been blessed with a great team but anytime you hire new employees, there's always the risk that you get a bad apple.

Yesterday our newest hire who is about 5 days into her job...had her pot dealer stop by for lunch, get high in the car together, then try to come back into work smelling strongly like marijuana. She passed a drug screen, a background check....but you never know and sometimes people eventually show you their true colors.

Lucky My staff called it out right when she returned from lunch and she never had any patient interaction after returning from lunch smelling of a strong odor.

Keep grinding it y'all! This is a part of the reason why I have no issue overpaying got good talent. Good help is hard to find haha

I just negotiated for a 9% raise this year from Aetna a few months ago. Now every single level 4 visit we bill since I negotiated that raise, they are requesting records on every visit before paying.

It feels like a bit retaliation from our recent pay raise. We have not been downcoded yet by Aetna for any notes + claims we send to them, but my billers are having to send any claim to Aetna that is level 4 or 5 before we get paid now.

We have not received notice from Aetna that we are under any formal review. our rep just tells us this is new standard protocol.

Anyone else going through this with Aetna?

I’m wondering if anyone had experience setting up a weight loss clinch within their primary or subspecialty practice? I imagine that someone smarter than me has come up with a successful business model for managing patients weight and helping them get GLP1s and manage that as well. I just don’t know how to structure the fee? Is it a subscription service? Is it a one-time fee for a certain amount of weeks of care? Would love to hear anyone’s ideas or experiences. Thanks.

I’ve heard now from several brokers and consultants that big named malpractice insurance companies (starting later this year) are no longer covering telehealth. Has anyone else heard this?

I’m looking to start right off the bat. Ive been reading and have a plan in place but what are the biggest pitfalls I can expect in this process. what surprised you when you started?

i am almost 40 so I don’t wanna waste a year or two working in another clinic.

the idea of owning a clinic really excites me. plus owning a business in America is the way to move.

any help is welcome!

Larger family of all doctors in the Midwest. I am the only one in business and real estate. I own a building in an upscale area, looking to start and manage a medical clinic either DPC OR CONCIERGE. 5,500SF facility. The specialities in the family are listed below. Which route would you recommend I focus on? I want to setup a collection based comp package where they can add 1-2 days of work a week and are paid %of collections.

Specialties in the family: Gi, Endocrinologist, Pulm, Cardio(x2), Anesthesia, Pain Management , Derm(still in residency) & physch.

Did you pay someone to draft all the documents? The Hipaa regulations look daunting to me. There is no way everybody has all the compliance work done like the regulation says… how much work is all the Hipaa stuff in your practice?

Not happy with the absolute horrible rates I'm getting from wells Fargo. Looking to switch for the cash just sitting there as a rainy day buffer.

Which business banks are you using for your business checking or savings accounts that have a decent interest rate?

Hey everyone, I posted a short message last week, promoting starting of a private practice, hoping to motivate whoever reads it to start private practice or to just not give up. I just wrote it because I felt like doing it. Not thinking much of it. But the amount of love (& DMs) I got in last 7-8 days since the post has been immense. I was not expecting that at all. I was actually away from Reddit for a few days.

But, reading that, and seeing the response I feel I have more to offer. So one other thing I would like to say is - if you are starting a practice, use technology to its maximum potential. It is not an easy journey, and you should use every tool available at your disposal to make your life easier.

1. Get an EHR. Managing spreadsheets looks cheap and stuff but its actually painful as you scale. Notes, scheduling, telehealth, billing - these days EHRs have so much features that you will easily save 8-10 hours per month. That's like 3-4 extra sessions. Just do it. There are enough options available - Sessions (recently switched to it), Simple Practice, etc.

2. Taxes: This is a big one especially since none of us was taught this in school. But, just use chatgpt and youtube. I almost ask everything to chatgpt about my finances and taxes these days. Use it for every question you wonder about late at night (e.g. what can be termed as business expenses) - You will save so much money on consulting and taxes that you might want to gift me something from it. I accept Amazon vouchers :D

3. Insurance credentialing: If you can invest a little, work with one of these guys Headway, Alma, Rula and close it faster. Insurance is a great way to ramp up practice initially. I am personally a fan of keeping a good mix. If not, then invest in a good website (Wordpress) for marketing to cash patients.

4. AI scribes: This is another life saver if you can get yourself to adopt it. It is such a mental unblock when you know your notes are not piling up. Just spend 2-3 hours to read all the notes and finalise them before you submit. Atleast get your insurance work done on time. I personally use Supanote but I also liked Mentalyc when I was trying. I chose Supanote because of its EHR integrations.

5. Do all your scheduling through links using EHR so that everything about your practice is in sync all the time. That's why my first suggestion was get a good EHR.

6. If you are into creating content for any thing (flyers, social media, etc) - Canva is an absolute must. It has just so many templates to choose from that its crazy. I can make any design in less than an hour.

7. Bookkeeping: Get a separate credit card for all your practice related expenses, and never mix your expenses. Otherwise it gets really frustrating at year end when you have to bifurcate. Categorize monthly, and use an accounting software Quickbooks.

8. Telehealth: Nothing much to say here because you cannot really do this without using technology. Anything that works for you should be fine here. Again, something with EHR integration should be prioritized.

9. Appointment reminder / practice management: I hate when clients miss appointments especially for reasons such as "slipped my mind" so having a system to automatically remind them is actually very useful. I do not have data but I know my missed appointments have reduced a lot over the years. Most EHRs have it from what I know. Atleast Sessions has it.

10. Communication: I don't use a separate tool except my EHR. I dont see the need of it but you can try one. But, as long as you keep all the patient related information outside your comm tools, you dont really need one.

In case I have missed anything, please do remind me. But, the idea I want to put across is that you are not alone, and you dont really need to struggle. There are so many good tools available today which can make your so much easier - all the client wants is a great therapist.

Hi all,
I’m looking to offer primary care as a VA Community Care Network physician. Already part of optum. What do I need to do in order to make the VA aware we’re offering these services? Also, is there any specific training that has to be done?
Thanks!

Looking for malpractice insurance options for private primary care practice in Oklahoma. Currently have PLICO.