r/PrivatePracticeDocs

Hi! I had a new ethical dilemma come up today at a practice I work at and wanted to get some opinions on it. For background I work at a psychology practice (out of network/private pay 3k-6k for testing). I recently was curious to get tested myself and was shocked to discover that even with insurance I’d still have to pay 2k out of pocket. I can’t believe patients have to go through this, its unfortunate. I was already feeling down about it when I was informed that my company was thinking about passing the 3-5% processing fees onto patients. For reference, 97% of our patients use a credit card. I was horrified and shut it down immediately. While I do understand what credit and insurance companies are doing is disastrous, I think turning around and putting it on the patient is unethical in my eyes, though it is legal. What do you think?

Any suggestions for any DPC support groups? I tried to join the one from the dpc docs on Facebook and even after having my dpc preceptor vouch for me I was denied because my Facebook account was too new. Now I’m first year out of residency and could really use some support with little questions here and there.

Our AR over 90 has been climbing for about four months (we're a 6-provider derm practice). When I ask our billing company about it i get a version of "we're working on it" without a real plan. denial reasons, payer-by-payer breakdown, follow-up cadence, nothing comes back in any structured way.

I'm split on what to do:

1. push harder and demand real reporting, give them a 90-day window to turn it around
2. start looking at other RCMs and just rip the bandaid

What I'm worried about with option 2 is the transition, specifically: what happens to the existing 90+ AR when we switch? Does it just sit there with the old vendor who has zero incentive to work it once we give notice. or does the new biller take it over as part of onboarding.

Anyone been in this spot recently and gone either route? Curious what tipped you one way or the other and how the transition actually played out if you switched.

I just purchased my own building to start my urgent care and urgent primary care. This clinic is located in North Carolina. FM Hospitalist transition to outpatients. Going to do remote patient monitoring, Substance use disorder, urgent care and some chronic management. What’s the profit margins for year 1-3? I’m going to be owner and provider and will hire 1 NP/PA.

What printer do you use that can meet my needs: Office quality, easy to set up, just hit my print button on my computer and it prints, I don’t have to buy ink or toner more than every a few months, is capable of printing hundreds of pages at once, and can scan documents more than one page at a time (I don’t want to physically have to feed it one page at a time to scan 10 pages. I want to just put 10 pages in the feeder and walk away and it scans them)?

I’ve been through seven printers in the past two years HP, Canon, Brother etc. All of them just start malfunctioning. I’m not rough with them. I just set them in my office and that’s it. it’s just over time they stop working. The one that I bought that’s the most expensive only works if I jiggle the wires a certain way. Thanks!

Going to be starting cards fellowship soon. Ultimate goal is starting my own practice. I already have a group of 5-6 friends going into cards also wanting to start their own thing. Since we are so early in the game, I wanted to ask what resources/conferences/networking opportunities I should pursue to give myself the best foundation to eventually open my own PP?

Plan is for all of us to negotiate first attending job aggressively for the best non-compete agreement we can find in a market like Texas, Florida etc to build patient base, save aggressively to get capital, and build reputation in community. My goal is ultimately have a set up where we have 2-3 general guys, 1-2 Interventional, 1-2 EP with ASC/OBL ownership and imaging equipment.

The biggest challenges I see to this plan are the following:

1. Negotiating payment agreements with insurance companies without leverage at the beginning. Possible solution is using a PE company that has negotiating power already but they take 25-35% of gross revenue. Is it better to start with less optimal payer agreements and renegotiate as practice builds? Or is the hassle not worth it?

2. Finding a geographic location that doesn’t already have a chokehold on the area (e.g. giant PE backed groups or big hospitals)

3. Medical billing: how difficult is it to learn how to do this optimally in house instead of outsourcing to a medical billing company that takes a large percentage?

4. Ramp up timeline : obviously we can’t build out an entire cath lab and ASC with millions of dollars of imaging equipment at the beginning. From my understanding it seems most logical to start with cheaper modalities like ultrasound and build out as practice grows. Not sure how this would work and what IC and EP guys would do in the meantime before building out cath lab other than taking STEMI call, rounding on hospital patients and doing mostly Gen cards work for the first couple years

What other roadblocks should I anticipate? What skills do yall recommend I focus on or things I should study up on during fellowship to make my dream a reality?

How feasible would it be to start a practice from scratch with our own capital?

Hey everyone,
I’m a cybersecurity founder (specializing in Agentic AI) who got frustrated watching small practices struggle with fragmented tools, burnout from charting, and rising cyber threats.
So I built MedGuard AI — a true all-in-one AI Practice OS designed for solo, small, and mid-sized practices.
Current Features:
• Real AI ambient/voice Clinical Notes (SOAP + ICD-10/CPT suggestions)
• Smart Intake forms with red-flag alerts that auto-generate draft notes
• Legal/Consent document generator (HIPAA, Telehealth, Texas-specific, etc.)
• Agentic AI Cyber Hygiene dashboard (breach alerts, phishing simulations, risk scoring)
• Self-serve Data Migration Wizard (PDFs, Excel, old EHR exports)
• Chrome Extension for EHR push
• Shared patient workspace + Visit Prep summaries + Patient Instructions
Goal: One clean, affordable platform instead of 4–5 separate tools.
Pricing (at launch):
Pro $99/mo | Premium $199/mo | SMB/Group $299/mo
Right now I’m looking for 10–15 serious beta testers (especially solo docs, small groups, primary care, or Texas practices) who are willing to give honest feedback. In return, you’ll get free access during beta + big discounts when we launch.
If you’re tired of pajama-time charting, switching between tools, data migration headaches, or cyber/compliance stress — I’d love to get this in your hands.
Comment below or DM me if interested. Happy to hop on a quick 10-min demo.
Looking forward to your thoughts!

Well, about starting private clinic, primary care. ( I am IM trained, hospitalist slowly going to outpatient world. For this year, will keep part time nocturnist position for better/smooth transition). DEA/State licenses are done. Location- bucks county PA, will be sharing office with podiatry for now.

1. can someone walk me through t make sure iM on right track. I cannot start credentialing before locking office address/location, right? I already reached agreement with podiatry doc office to share the office.

2. for now, I will start as cash based (I know/in contact with a company with a couple hundred seasonal workers. That company is fasilitating "seasonal DPC" type of agreement with me, so at least I have soemthing to start with).

3. Next. Im struggling to find/hire office manager or a company who can start credentialing and other primary care clinic setup. Any rec.s?

4. Any rec.s or what you have done differently If you are about starteing a new primary care clinic?

5. Any other thoughts or recs are appreciated.

Thanks

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.

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 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.

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.

If there is one thing I have learnt about dealing with insurance cos., it is just just do the Paperwork properly.

Clawbacks, audits, non-payments, etc have nothing to do your skills. Trust me. You might be following the best plan but if your notes do not explain why the plan is needed, you are more likely to fail audits than pass them. You codes should in place, no clerical errors, ec etc.

To be honest, its very simple from the way I see it - payer companies have rules and you just need to make sure you follow them for a good practice which includes proper documentation, accurate billing structures, etc etc.

One thing I used to do very sincerely was reading the provider manuals by insurance companies. Nowadays, you can just use chatgpt but I would suggest you to read it atleast once. Chatgpt might be great for answering questions but not for an overall plan (I have tried it).

Once you understand that, then all you need do is to make sure all your paperwork align with contract language.

Hope it helps someone!

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.

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.