# The Practice Vendor Review — Full content

> Independent, criteria-based vendor selection for independent medical practices.
> Last reviewed 2026-07-23. Every numeric claim below is cross-referenced with a primary source at /key-statistics.

This file mirrors the site's substantive reference content — pillar buyer guides, evaluation criteria, benchmarks, statistics, and glossary — as plain markdown for LLM ingestion. For a compact index of URLs see /llms.txt.

## Pillar buyer guides

### Medical Billing & RCM

URL: /billing-rcm

**Quick answer:** The best medical billing company for an independent practice is the smallest, most transparent partner whose specialty experience, technology, and pricing model match your claim volume. Avoid percentage-of-collections vendors who won't disclose their denial rate, first-pass acceptance rate, or days-in-AR by client. Insist on a 30-day out clause, direct clearinghouse access, and written performance SLAs before you sign.

Who this is for: Solo and small-group physician practices, therapy and behavioral health clinics, and specialty practices under 15 providers evaluating billing service vendors or considering a switch from in-house.

#### How to choose (/billing-rcm/how-to-choose)

1. **Baseline your current numbers first** — Before you talk to a single vendor, calculate your current cost of collection as a percentage of net collections. Include salaries, benefits, PMS/clearinghouse fees, and a share of overhead. Most independent practices land between 6% and 12%. That number is your break-even against any outsourced quote.
2. **Match vendor size to your claim volume** — National RCM giants price for hospital groups. Regional specialists price for small practices. If you send fewer than 3,000 claims a month you almost always get better attention from a firm under 100 employees with several accounts your size in your specialty.
3. **Understand every pricing model on the table** — Percentage of collections is the norm (typically 4%–9%), but per-claim, hybrid, and flat-fee models exist. Percentage aligns incentives on collections but penalizes high-reimbursement specialties. Per-claim rewards clean claims but can leave denials un-worked. Ask which claims are excluded (self-pay, small balances, patient billing).
4. **Demand real performance metrics from real clients** — First-pass claim acceptance (should be 95%+), net collection rate (should be 95%+ against contracted rates), days in AR (should trend under 35 for most specialties), and denial rate by category. Ask for a client of similar size and specialty you can call.
5. **Verify who owns the software and the data** — If the vendor forces you into their proprietary practice management system, migration off them is painful by design. Prefer vendors who can work in your existing EHR/PM. Confirm daily data exports, contract-end data handover, and clearinghouse account ownership in writing.
6. **Read the contract for the exit, not the entry** — Look for: month-to-month or 30-day termination clauses, no automatic multi-year renewals, no data ransom clauses, clear responsibility for legacy AR at termination, and a defined dispute process. A vendor confident in their service does not need to lock you in for two years.
7. **Insist on a named account manager and SLA** — Response-time SLAs for provider questions and patient billing inquiries, plus a named point of contact — not a ticket queue. Ask what happens when that person leaves.

**Common mistakes:**
- Comparing vendors on headline percentage only, ignoring what's excluded from that percentage.
- Signing a multi-year contract with a large national RCM firm because it feels 'safe.'
- Not benchmarking current in-house cost of collection before shopping.
- Accepting 'we don't share client references' as an answer.
- Letting a vendor put you on their PM system without a data-portability clause.

**Red flags:**
- Refuses to disclose first-pass acceptance rate or days-in-AR.
- Requires a 2-year or 3-year initial term with auto-renewal.
- Owns your clearinghouse account or payer credentialing on their tax ID.
- Bundles credentialing 'for free' but won't quote it separately.
- Cannot name a client of your specialty and size for a reference call.

#### Evaluation criteria (/billing-rcm/evaluation-criteria)

Use these weighted criteria to score any medical billing or RCM vendor consistently. Print the sheet, score each vendor 1–5 on every criterion, multiply by weight, and compare totals. Weights add to 100.

| Criterion | What to look for | Weight |
| --- | --- | --- |
| Specialty experience | Multiple current clients in your specialty at your size. Understands your top 10 CPT codes and payer mix without prompting. | 15 |
| Performance transparency | Will share first-pass acceptance, net collection rate, days in AR, and denial rate by category. Provides monthly dashboards, not quarterly PDFs. | 15 |
| Pricing model fit | Model matches your volume and reimbursement profile. All exclusions (self-pay, patient billing, appeals) disclosed in writing. | 12 |
| Technology & data portability | Works in your EHR/PM. Daily exports available. You own the clearinghouse account and credentialing. | 12 |
| Contract terms | 30-day termination, no auto-renewal, defined legacy AR handling, dispute process. | 10 |
| Denials management | Written appeals workflow. SLA on time-to-first-appeal. Reports denial reasons back to the practice, not just re-worked totals. | 10 |
| Patient billing & experience | Modern patient statements, online pay, transparent process for patient inquiries, defined escalation to practice. | 8 |
| Onboarding rigor | Written 60–90 day onboarding plan, credentialing verification, fee schedule loading, and go-live checklist. | 8 |
| Account management | Named account manager, defined response SLAs, quarterly business reviews with your specific numbers. | 6 |
| Compliance & security | HIPAA BAA, SOC 2 Type II or equivalent, documented breach response, background checks on offshore staff if used. | 4 |

#### FAQ

**Q: What percentage do medical billing companies charge?**

Most percentage-of-collections billing companies charge between 4% and 9% of net collections. Small practices and low-reimbursement specialties trend toward the higher end; large-volume or high-reimbursement practices negotiate to the lower end. Per-claim pricing typically runs $4–$8 per claim depending on complexity.

**Q: Is outsourced billing cheaper than in-house?**

It depends on volume. Below roughly 3,000 claims per month, outsourcing is almost always cheaper than a full-time in-house biller once you include salary, benefits, software, and the cost of coverage during time off. Above that volume the math tightens and depends on your specialty's reimbursement and your current cost of collection.

**Q: What is a good first-pass claim acceptance rate?**

For most specialties, 95% or higher on first-pass acceptance is the mark of a competent billing operation. Below 90% signals rushed submission, weak scrubbing, or credentialing gaps. Ask any prospective vendor for their book-of-business average, then for your specialty's average within that book.

**Q: How long does a billing vendor switch take?**

Plan for 60 to 90 days from contract signature to steady-state. Weeks 1–4 cover credentialing verification, fee schedule loading, and clearinghouse setup. Weeks 5–8 run parallel processing on new claims. Legacy accounts receivable — who works claims filed before go-live — is the single most negotiated point; get it in the contract.

**Q: Should I let the billing company use their own practice management system?**

Only if the contract guarantees daily data exports, that you own the payer credentialing and clearinghouse account, and that data at contract end is delivered in a portable format at no cost. Otherwise the switching cost of leaving that vendor becomes a soft lock-in.

**Q: What's the difference between medical billing and revenue cycle management?**

Medical billing is the narrower activity of coding, submitting claims, posting payments, and working denials. Revenue cycle management (RCM) covers the full arc from patient scheduling and eligibility verification through final collections and reporting. Most modern billing vendors offer RCM; the label matters less than the scope of the statement of work.

---

### Credentialing & Payer Enrollment

URL: /credentialing

**Quick answer:** The best credentialing service for an independent practice is one that quotes per-payer (not per-provider bundles), owns the follow-up cadence in writing, keeps CAQH and NPI ownership with you, and shares weekly status by payer. Expect $100–$300 per payer per provider for initial enrollment. Anyone quoting 30-day universal timelines is either lying or only handling Medicare.

Who this is for: New practices, providers joining an existing group, practices adding a new location or tax ID, and any group re-credentialing more than three providers at once.

#### How to choose (/credentialing/how-to-choose)

1. **Separate credentialing from enrollment** — Credentialing (verifying identity, license, education, and history) and enrollment (getting on a payer's panel and fee schedule) are two different workflows. A good vendor is explicit about which they do and which they hand off. If a vendor blurs the two in their quote, you'll be surprised at go-live.
2. **Own your NPI, CAQH, and PECOS accounts** — The vendor should work inside your accounts, not create parallel ones they control. Log-in credentials to CAQH, PECOS, and the state licensing portals stay with the practice. If a vendor asks to 'own' these on your behalf, walk away.
3. **Ask for the payer list, not the total** — A quote of '$5,000 for full credentialing' is meaningless without the payer list. Get a per-payer, per-provider breakdown. Understand which payers are closed panels in your area — no vendor can conjure a panel that is not accepting new providers, and any that claims otherwise is misrepresenting.
4. **Get the follow-up cadence in writing** — Payer applications go silent. The difference between a 90-day enrollment and a 210-day enrollment is who calls the payer credentialing rep every two weeks. Insist on: weekly status updates by payer, escalation contacts, and a hard SLA on time-to-first-follow-up after silence.
5. **Understand realistic timelines** — Medicare (PECOS): 45–90 days. Medicaid: 60–180 days depending on state. Commercial payers: 90–150 days. BCBS plans: highly variable by state, often the slowest. Anyone quoting universal 30-day turnaround is either only doing Medicare or setting you up to blame the payer later.
6. **Confirm re-credentialing and roster maintenance** — Enrollment is not one-and-done. Every payer re-credentials every 2–3 years. Ask if ongoing roster maintenance, CAQH re-attestation (every 120 days), and re-credentialing are included or billed separately.
7. **Read the exit clause** — At termination, the vendor should hand back a clean file per provider per payer: contract effective date, provider ID numbers, portal logins, and any pending applications. Get this in the contract.

**Common mistakes:**
- Waiting until after lease signing and hiring to start credentialing — a 90-day process starts before you open the doors.
- Assuming a new provider can bill under a group's tax ID without their own enrollment on file.
- Letting CAQH lapse and re-attestation fail — payers pull it silently and terminate.
- Not confirming panel status (open vs closed) before spending on an application.
- Treating one credentialing contact per payer as sufficient; escalation contacts matter.

**Red flags:**
- Refuses to share credentials to CAQH, PECOS, or state portals with the practice.
- Quotes a single flat number without a per-payer breakdown.
- Promises 30-day universal turnaround across all payers.
- Cannot show a sample weekly status report from an existing client.
- Bundles credentialing 'free' with a billing contract you have not fully negotiated.

#### Evaluation criteria (/credentialing/evaluation-criteria)

Score each credentialing vendor against these weighted criteria. Weights add to 100.

| Criterion | What to look for | Weight |
| --- | --- | --- |
| Pricing transparency | Per-payer, per-provider pricing. All fees (application, expedite, re-credentialing) disclosed in writing. | 15 |
| Account ownership | CAQH, PECOS, NPI, and state portal credentials stay with the practice. Vendor works inside your accounts. | 15 |
| Follow-up cadence | Weekly per-payer status. Named escalation contacts at each payer. SLA on time-to-first-follow-up after silence. | 15 |
| Reporting quality | Live tracker per provider per payer with dates, status, and next action. Not a monthly PDF. | 12 |
| Payer coverage | Handles Medicare, Medicaid, and all commercial payers relevant to your specialty and state. | 10 |
| Ongoing maintenance | CAQH re-attestation every 120 days, re-credentialing, roster maintenance included or clearly priced. | 10 |
| Specialty & state experience | Current clients in your specialty and state. Knows which BCBS plans are closed panels in your area. | 8 |
| Turnaround realism | Payer-by-payer realistic estimates. Does not promise universal 30-day turnaround. | 6 |
| Contract exit terms | Clean per-provider per-payer file at termination. No lock-in of credentials. | 5 |
| Compliance & security | HIPAA BAA, background checks, secure document handling. | 4 |

#### FAQ

**Q: How long does medical credentialing take?**

Realistic ranges by payer: Medicare 45–90 days, Medicaid 60–180 days depending on state, commercial payers 90–150 days, and BCBS plans anywhere from 90 to 210 days depending on state. A full enrollment cycle for a new provider across a typical payer mix runs 90–150 days.

**Q: What does credentialing cost?**

Expect $100–$300 per payer per provider for initial enrollment through a service, plus optional monthly maintenance of $30–$100 per provider. Flat 'full credentialing' quotes without a per-payer breakdown almost always exclude something material.

**Q: Can I do credentialing myself?**

Yes, and many single-provider practices do. Plan for 20–40 hours of upfront work to build CAQH, PECOS, and payer applications, then 1–3 hours per week of follow-up per payer for three to five months. If your time is worth more than $50 per hour, a competent service typically pays for itself.

**Q: What is CAQH and do I need it?**

CAQH ProView is a shared credentialing database most commercial payers pull from. You attest to your information every 120 days. Any US provider treating commercial insurance patients needs a current CAQH profile.

**Q: Can I bill under a group's tax ID before my own enrollment is complete?**

In most cases, no. Payer contracts tie to the individual provider's NPI enrolled under that group's tax ID. A few payers allow retroactive effective dates, but planning around retro-billing is a bad idea. Start credentialing a new hire 90 days before their start date.

**Q: What's the difference between credentialing, enrollment, and privileging?**

Credentialing is verifying a provider's identity, license, education, and history. Enrollment is adding that provider to a specific payer's panel and fee schedule. Privileging is a hospital granting a provider permission to perform specific procedures. All three overlap in vocabulary and none substitute for the others.

---

### EHR & Practice Software

URL: /ehr

**Quick answer:** The best EHR for an independent practice is the one purpose-built for your specialty at your size, priced predictably per provider, with a documented data-export path and reference clients who match your workflow. Every horizontal 'EHR for everyone' claim collapses under specialty workflow load. Budget 6–12 months, insist on live specialty references, and never sign at the demo.

Who this is for: Solo and small-group practices selecting a first EHR, replacing a legacy system, or spinning up a new specialty line requiring different documentation.

#### How to choose (/ehr/how-to-choose)

1. **Specialty first, everything else second** — The single biggest predictor of EHR satisfaction is specialty fit. A behavioral health practice on a general-primary-care EHR will spend two hours a day fighting templates. Filter your shortlist to systems with real specialty modules and at least a dozen practicing clients in your specialty at your size.
2. **Define your must-haves before the first demo** — Write down: required integrations (labs, imaging, e-prescribing controlled substances, patient portal, telehealth), required documentation types, required reporting for your payer mix and any quality programs (MIPS, HEDIS), and required device support. Score demos against this list, not against how impressive the sales deck feels.
3. **Understand the true pricing model** — Per-provider-per-month is standard ($200–$600) but the total is bigger. Ask about: implementation and setup fees, training fees, data migration fees, integration fees per interface, patient portal fees, e-prescribing controlled substance fees, and annual increases. A cheap monthly rate can double when the implementation invoice arrives.
4. **Interrogate the migration plan** — If you have historical data, migration is where projects fail. Ask: what data comes over structured (medications, allergies, problems) vs as PDFs? Who does the mapping? How much test cycle time? What is the go-live cutover plan? Get the migration statement of work as a separate document.
5. **Test the workflow with real charts, not a demo script** — Sales demos are choreographed. Insist on a hands-on session where your team documents a complete visit from check-in to note completion and claim generation using your specialty's templates. Time it. Compare across vendors on the same test case.
6. **Call reference clients your size in your specialty** — One phone call to a same-specialty same-size client is worth ten demos. Ask about implementation timeline vs plan, support response times, unexpected costs, and what they would do differently.
7. **Confirm data ownership and export rights** — You own your patient data. The contract must state it, and must guarantee a complete export at termination in a usable format (CCDA plus structured tables), at no cost, within a defined window. Vendors who charge for data export at exit are creating switching costs.

**Common mistakes:**
- Buying on price alone — the cheapest EHR is often the most expensive over three years.
- Skipping a hands-on workflow test in favor of the sales demo.
- Not budgeting for the productivity dip in months 1–3 post go-live.
- Assuming interfaces to your lab, imaging, or billing vendor are free and instant.
- Signing a 3-year contract before completing a full workflow test.

**Red flags:**
- Cannot name five reference clients in your specialty at your size.
- Refuses to quote implementation and migration as fixed-price or capped.
- Charges for data export at contract termination.
- Sales rep says 'we do everything' when asked about a specific specialty workflow.
- Roadmap items you were promised at demo are not in a written commitment.

#### Evaluation criteria (/ehr/evaluation-criteria)

Score each EHR against these weighted criteria. Weights add to 100.

| Criterion | What to look for | Weight |
| --- | --- | --- |
| Specialty fit | Purpose-built templates, workflows, and reporting for your specialty. Multiple client references in your specialty at your size. | 18 |
| Documentation speed | Measured in a hands-on test using your real visit type. Note completion time, clicks per encounter, mobile support. | 14 |
| Total cost of ownership (3 years) | Monthly per-provider fee, implementation, training, migration, integrations, portal, e-prescribing, annual increases. | 12 |
| Integrations | Live interfaces to your labs, imaging, referral network, billing platform, and telehealth. Cost per interface disclosed. | 10 |
| Data migration & portability | Migration scope in writing. Complete data export at termination free and in a usable format within a defined window. | 10 |
| Implementation & training | Fixed-price or capped implementation. Named project manager. Role-based training plan. Realistic timeline. | 8 |
| Support quality | US-based hours, SLA on response, named account manager, escalation path, published uptime. | 8 |
| Reporting & analytics | MIPS/HEDIS if applicable, practice financial reports, custom report builder, easy data export. | 6 |
| Patient experience | Modern patient portal, online scheduling, self-pay flows, integrated telehealth, appointment reminders. | 6 |
| Compliance & security | HIPAA BAA, SOC 2 Type II, HITRUST or equivalent, breach history, MFA, audit logging. | 4 |
| Contract terms | 1-year initial term acceptable, no auto-renewal traps, defined offboarding, price-increase caps. | 4 |

#### FAQ

**Q: How much does an EHR cost for a small practice?**

Cloud EHRs for independent practices typically run $200–$600 per provider per month, plus implementation ($1,500–$10,000 per provider) and migration if applicable. Integrated EHR + practice management + billing bundles run higher, $500–$1,200 per provider per month. Three-year total cost of ownership is a better comparison than monthly rate.

**Q: How long does an EHR implementation take?**

For a small practice with no data migration, 60–120 days from contract to go-live is realistic. With historical data migration, plan 4–9 months. Anyone selling a 30-day implementation for a real practice is either doing a minimal setup or setting you up to blame delays on your team.

**Q: What is the best EHR for a private practice?**

There is no single best EHR. The best EHR for your practice is the one purpose-built for your specialty at your size, at a total-cost-of-ownership you can afford, whose reference clients your size in your specialty are genuinely satisfied. A specialty-first shortlist beats a 'top 10 EHRs' list every time.

**Q: Should I choose a specialty EHR or a general one?**

For most independent specialties (behavioral health, PT/OT, dermatology, ophthalmology, pediatrics, and others), a specialty-purpose-built EHR outperforms a general one on documentation speed and reporting. General EHRs make sense for multi-specialty groups and primary care with heavy interoperability needs.

**Q: Can I switch EHRs? How hard is data migration?**

Yes, and thousands of practices switch every year. Structured data (medications, allergies, problem lists) migrates via CCDA. Unstructured historical notes usually come over as PDFs attached to the patient chart. Budget 4–9 months, insist on a fixed-price migration statement of work, and negotiate the export rights from your outgoing vendor before you sign with the new one.

**Q: Do I need practice management software separately from an EHR?**

Most modern cloud EHRs include practice management (scheduling, billing, patient accounts) in the same platform. Standalone PM systems still exist for practices that want to keep a specialty EHR but a stronger billing engine. If you outsource billing, coordinate PM choice with your billing vendor.

---

### Ambient AI Scribes

URL: /ai-scribes

**Quick answer:** The best AI scribe for an independent practice is the one with a native, structured integration into your EHR, measured accuracy in your specialty on real patient encounters, transparent per-provider-per-month pricing, and a real month-long pilot with your own providers. Feature parity is closer than vendors admit; the differences that matter are EHR write-back depth, specialty vocabulary handling, and support responsiveness. Never buy on demo; always pilot.

Who this is for: Independent practices adding AI documentation for the first time, or switching between scribe vendors, in any specialty where clinician documentation time is a top-3 pain point.

#### How to choose (/ai-scribes/how-to-choose)

1. **Define what you want the scribe to do** — Ambient scribes are not all the same product. Some produce a note draft the provider edits. Some write structured data (medications, problems, orders) back to the EHR. Some handle after-visit summaries and patient-facing content. Decide the scope before you shop, because pricing and integration depth vary sharply.
2. **Verify EHR integration depth, not just the logo list** — Every scribe vendor lists every major EHR on their integration page. The real question is: does the note write into the correct chart location automatically, or does the provider still copy-paste? Does the vendor write structured data (medications, orders) or only free text? Does the integration require the provider to launch a separate app, or does it live inside the EHR?
3. **Test specialty vocabulary on real encounters** — Accuracy on a general internal medicine visit is not accuracy on a psychiatry, PT, ophthalmology, or dermatology visit. Ask for a 2–4 week pilot on real encounters with your actual providers. Measure: provider edit time per note, error rate on specialty-specific terms, and provider satisfaction after two weeks — not the first day.
4. **Understand the pricing model completely** — Ambient scribes typically run $99–$399 per provider per month. Watch for: usage caps (encounters or minutes), overage fees, tiered pricing that changes with volume, and setup or training fees. All-you-can-use flat-rate pricing exists but is trending down as vendors face real inference cost.
5. **Confirm privacy, PHI handling, and model training** — The vendor must sign a HIPAA BAA. Confirm in writing: PHI is not used to train models unless you opt in, audio and transcripts are retained only as needed, encryption in transit and at rest, and geographic hosting. If the answer to 'do you train on our data' is anything other than a clear 'no by default,' walk.
6. **Test the failure modes** — What happens when the recording drops? Multi-speaker rooms? Heavy accents? Non-English patients? Interruptions? A good vendor lets you test edge cases in pilot. Ask about their error-correction workflow — how a provider flags a bad note and how the vendor uses that feedback.
7. **Read the contract for the exit** — Month-to-month or short-term commitments are standard in this category and should stay that way. Watch for auto-renewal, per-provider seat lock-ins, and data-portability of your historical note drafts.

**Common mistakes:**
- Signing a 12-month contract after a one-week demo.
- Skipping the multi-provider pilot in favor of a single-champion trial.
- Not measuring provider edit time per note during pilot — the number that actually matters.
- Ignoring the difference between free-text note write-back and structured data write-back.
- Assuming accuracy on generic clinical text implies accuracy in your specialty.

**Red flags:**
- Cannot show a real, live integration into your EHR (only screenshots).
- Refuses a 2–4 week paid or free pilot.
- Uses PHI for model training by default with an opt-out.
- 12+ month initial term with auto-renewal.
- Vague on structured data write-back vs. free text.

#### Evaluation criteria (/ai-scribes/evaluation-criteria)

Score each AI scribe vendor against these weighted criteria. Weights add to 100.

| Criterion | What to look for | Weight |
| --- | --- | --- |
| EHR integration depth | Native integration with your EHR. Note writes to correct chart location automatically. Structured data write-back (meds, orders) not just free text. | 18 |
| Specialty accuracy (measured in pilot) | Provider edit time per note, error rate on specialty vocabulary, provider satisfaction after 2 weeks of real use. | 16 |
| Privacy & PHI handling | HIPAA BAA, no model training on your data by default, defined retention, encryption in transit and at rest. | 12 |
| Pricing transparency | Per-provider-per-month rate, usage caps disclosed, no surprise overage fees, month-to-month available. | 10 |
| Provider workflow fit | Fits inside existing exam-room and workflow. Handles multi-speaker, interruptions, in-room and telehealth. | 10 |
| Note quality & customization | Note structure matches your specialty. Templates customizable. Provider voice preserved. | 8 |
| Support & onboarding | Named contact, US-hours support, defined onboarding for new providers, feedback loop for note quality. | 8 |
| Reliability & uptime | Published uptime, graceful failure (nothing lost if audio drops), status page. | 6 |
| Contract terms | Month-to-month or short-term commitments, no auto-renewal traps, defined offboarding. | 6 |
| Roadmap & vendor stability | Funding runway, real customer base, product roadmap that matches your needs. | 6 |

#### FAQ

**Q: How much does an AI medical scribe cost?**

Ambient AI scribe pricing typically runs $99–$399 per provider per month. Lower tiers cap usage (encounters or audio minutes). Flat-rate all-you-can-use pricing exists but is trending toward tiered as vendors face real inference costs. Enterprise deals for larger groups can go below $150 per provider per month.

**Q: Do AI scribes work with my EHR?**

Most major AI scribes list integrations with every major EHR. The real question is integration depth: does the note write to the correct chart location automatically, or does the provider copy-paste? Does the scribe write structured data (medications, orders) or only free text? Test this in a real pilot, not from a screenshot.

**Q: How accurate are AI medical scribes?**

Accuracy varies sharply by specialty and by encounter type. General internal medicine visits are the sweet spot for most vendors. Specialty vocabulary (psychiatry, dermatology, ophthalmology, PT/OT), non-English patients, and multi-speaker rooms are where vendors differ. The only way to know is a 2–4 week pilot with your actual providers.

**Q: Is patient data safe with an AI scribe?**

Any legitimate vendor signs a HIPAA BAA. The additional question that matters: does the vendor use your PHI to train their models? Best practice is that PHI is not used for model training by default, with an explicit opt-in. Encryption in transit and at rest, geographic hosting, and defined retention should all be documented.

**Q: Do I need to tell patients an AI scribe is in the room?**

Consent practice varies by state law and by vendor implementation. Most vendors provide patient-facing consent language and signage. Confirm your state's recording law and your vendor's guidance. Many practices treat it like any other documentation aid and include it in general consent-to-treat paperwork.

**Q: How long does an AI scribe pilot take?**

Plan 2–4 weeks with multiple providers using the scribe on real encounters. Week 1 is workflow learning and adjustment; week 2 onward is where you can measure provider edit time per note, error rate on your specialty's vocabulary, and satisfaction. A one-week trial is a demo, not a pilot.

---

### Practice Consulting & MSOs

URL: /consulting

**Quick answer:** The best practice consultant for an independent practice is engaged for a defined scope, on a fixed-fee or capped-hourly basis, with clear deliverables and reference clients you can call. An MSO (management services organization) is a different animal — a long-term operational partner that owns billing, credentialing, HR, and often the tech stack, in exchange for a share of collections. Choose a consultant for a project. Choose an MSO only after understanding the multi-year economic and control tradeoffs.

Who this is for: Physicians starting a practice, groups considering an MSO or PPMC, and established practices facing a specific operational or strategic problem (payer negotiation, expansion, EHR selection, sale).

#### How to choose (/consulting/how-to-choose)

1. **Decide project vs. long-term relationship** — Consultants solve defined problems in defined windows: launch a practice, negotiate a payer contract, prepare for a sale, implement an EHR. MSOs and PPMCs are ongoing operational partners you cede real control to. These are not substitutable. Frame the engagement first, then shop.
2. **Insist on a scoped statement of work** — The single biggest consulting failure mode is scope creep with no clear finish line. Any consultant worth hiring will write a scoped SOW: deliverables, timeline, fixed or capped fee, out-of-scope process. If you cannot get an SOW before signing, you are buying an open tab.
3. **Match consultant experience to your specific problem** — A consultant who launches OB/GYN practices in Texas is not the same as one negotiating hospital-affiliated PPO contracts in New York. Ask for a client list of engagements matching your exact problem in the last 24 months. Call two of them.
4. **Understand fee structures and conflicts** — Fixed-project fee is cleanest. Hourly with a cap is acceptable. Percentage of savings or percentage of ongoing revenue creates alignment problems on scope. Any consultant recommending a vendor should disclose their relationship (referral fee, employment, ownership) in writing.
5. **For MSOs, model the multi-year economics** — MSO fees typically range 4%–15% of revenue depending on services included. Model the full cost against building the same functions in-house at your growth scenarios. Understand: what you give up (autonomy, brand, EHR choice, purchasing power), what you get (billing, HR, credentialing, group buying, sometimes capital), and how you exit.
6. **Read the exit terms** — For consultants: end-of-engagement handover, IP ownership of deliverables. For MSOs: how you leave, what you keep (patient records, contracts, staff), non-competes, and financial obligations at exit. MSO exits are notoriously friction-heavy; understand this before signing.
7. **Get references from clients who ended engagements** — Talking only to current clients is a bias trap. Ask for a reference from a client whose engagement ended (successfully or not). How the consultant handled the wind-down tells you more than a happy quote from a current client.

**Common mistakes:**
- Hiring a consultant without a written scope of work.
- Confusing a startup consultant with an MSO — the commitments and exits are radically different.
- Accepting percentage-of-savings fees for operational engagements.
- Signing an MSO agreement without modeling 5-year economics vs. status quo.
- Not asking any consultant for a same-specialty same-state reference in the last 24 months.

**Red flags:**
- Refuses a written scope of work.
- Won't disclose referral relationships with vendors they recommend.
- MSO with high revenue percentage and no clear breakdown of services.
- Cannot provide a reference from a former client (only current ones).
- Requires exclusivity or non-compete beyond the engagement.

#### Evaluation criteria (/consulting/evaluation-criteria)

Score each consultant or MSO against these weighted criteria. Weights add to 100.

| Criterion | What to look for | Weight |
| --- | --- | --- |
| Scope discipline | Written SOW with deliverables, timeline, and out-of-scope process before contract. | 16 |
| Specialty & problem fit | Recent engagements matching your specialty, size, geography, and specific problem. | 14 |
| Fee structure | Fixed-project or capped-hourly for consultants. For MSOs, clear percentage-to-services breakdown. | 12 |
| Reference quality | Same-specialty same-state references, including a former (not just current) client. | 12 |
| Conflict disclosure | Written disclosure of any vendor referral relationships, ownership, or employment. | 10 |
| Deliverable ownership | You own all IP created in the engagement. Templates, models, contracts are yours to keep and reuse. | 8 |
| Exit terms | Clean handover. For MSOs: what you keep, obligations, and timeline at exit. | 10 |
| Team & seniority | Named senior person on the engagement, not a bait-and-switch to juniors. | 8 |
| Communication cadence | Weekly touch points, defined reporting, single point of contact. | 6 |
| MSO-only: technology & purchasing | For MSOs, what tech and vendor contracts you're bought into. Group-purchasing terms disclosed. | 4 |

#### FAQ

**Q: What does a medical practice consultant cost?**

Independent consultants typically charge $200–$500 per hour, with defined-scope projects running $5,000–$50,000 depending on scope. Startup engagements (full practice launch) run $15,000–$75,000. MSO monthly fees are structured as 4%–15% of revenue depending on services included.

**Q: What is an MSO and how is it different from a consultant?**

A management services organization (MSO) is an ongoing operational partner that handles some or all of your non-clinical operations — billing, credentialing, HR, IT, purchasing — in exchange for a percentage of revenue or fixed fees. A consultant solves a defined project in a defined window. MSOs are long-term commitments with meaningful control tradeoffs; consultants are project-based.

**Q: Do I need a consultant to start a private practice?**

No, but many first-time practice owners find one is a good investment for entity setup, credentialing coordination, EHR selection, and payer contracts. A capped $15,000–$40,000 startup engagement typically pays back through faster time-to-first-claim and avoided rookie mistakes. Doing it yourself is possible; plan for 300+ hours over 6 months.

**Q: How do I vet a medical practice consultant?**

Ask for three recent engagements matching your specialty, size, and geography. Call two current clients and one former client. Ask about scope discipline, communication, and whether deliverables landed as promised. Require a written scope of work with fixed or capped fees before you sign anything.

**Q: Are MSOs a good deal for independent practices?**

It depends on what you value. MSOs deliver operational leverage, group-purchasing power, and often capital access. In exchange you give up autonomy on vendor choices, brand, and sometimes clinical decision support. Model 5-year economics against status quo, and understand exit terms fully. MSOs are not inherently good or bad; they are a specific tradeoff.

**Q: Can a consultant help me sell my practice?**

Yes, and this is one of the highest-ROI consulting engagements. A specialty transaction advisor with recent experience selling practices your size in your specialty will typically add multiples to sale price that dwarf their fee. Ask for at least three closed transactions in the last 18 months.

---

## Key statistics with sources

URL: /key-statistics · Last reviewed 2026-07-23

### Medical billing & RCM

- **Fully loaded cost of collection at independent physician practices:** 6% – 12% of net collections
  - Source: MGMA DataDive Cost & Revenue (2024) — https://www.mgma.com/data
  - Notes: Includes salaries, benefits, PM/clearinghouse fees, and allocated overhead. The break-even benchmark to compare any outsourced RCM quote against.
- **Typical outsourced RCM percentage fee for a small practice:** 4% – 9% of net collections
  - Source: HFMA / MGMA industry surveys (2024) — https://www.hfma.org/topics/map-keys/
- **Target first-pass claim acceptance rate:** ≥ 95%
  - Source: HFMA MAP Keys (2024) — https://www.hfma.org/topics/map-keys/
- **Target net collection rate against contracted allowables:** ≥ 95%
  - Source: HFMA MAP Keys (2024) — https://www.hfma.org/topics/map-keys/
- **Healthy initial claim denial rate for independent practices:** 5% – 10%
  - Source: MGMA / HFMA (2024) — https://www.mgma.com/data
  - Notes: Denial rates above 10% consistently signal front-end (eligibility, coding, or authorization) failures — not just payer behavior.
- **Target days in accounts receivable:** < 40 days
  - Source: HFMA MAP Keys (2024) — https://www.hfma.org/topics/map-keys/
- **Target percentage of A/R aged over 90 days:** < 15% – 20%
  - Source: HFMA MAP Keys (2024) — https://www.hfma.org/topics/map-keys/

### Credentialing & enrollment

- **Typical commercial-payer enrollment timeline:** 60 – 120 days
  - Source: CAQH ProView guidance & payer directories (2024) — https://www.caqh.org/solutions/caqh-proview
- **Medicare enrollment (PECOS) processing target:** 45 – 90 days
  - Source: CMS Medicare Provider Enrollment (2024) — https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification
- **State Medicaid enrollment window — meaningful variance by state:** 60 – 180+ days
  - Source: Medicaid.gov state directory (2024) — https://www.medicaid.gov/
- **Per-provider credentialing service fee (initial enrollment):** $200 – $500 per payer
  - Source: Industry survey of credentialing-as-a-service vendors (2024) — https://www.ncqa.org/programs/health-plans/credentialing/

### EHR & practice software

- **Cloud EHR + PM cost per provider per month (independent practice):** $300 – $700 PPPM
  - Source: KLAS Research & ONC market data (2024) — https://klasresearch.com/
  - Notes: Bundled EHR + practice management. Excludes clearinghouse pass-through and implementation.
- **Typical implementation / go-live window for a small practice:** 60 – 120 days
  - Source: KLAS / vendor implementation guides (2024) — https://klasresearch.com/
- **Realistic EHR migration timeline (contract → stable production):** 6 – 9 months
  - Source: KLAS / practice-manager surveys (2024) — https://klasresearch.com/
  - Notes: Includes data migration, workflow build, staff training, and stabilization.

### Ambient AI scribes

- **Ambient AI scribe per-provider list price:** $99 – $399 PPPM
  - Source: Vendor pricing pages & KLAS emerging-tech reports (2025) — https://klasresearch.com/
- **Physician time saved on documentation with ambient AI scribes (reported):** 0.5 – 1.5 hours per day
  - Source: Peer-reviewed pilot studies (JAMA Network Open, NEJM Catalyst) (2024) — https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820641
  - Notes: Reported ranges are self-reported and vary by specialty, encounter type, and template maturity. Treat top-of-range values as ceilings, not typical.
- **Target draft-note availability after visit close:** < 5 minutes
  - Source: Vendor SLAs and buyer interviews (2025) — https://chai.org/

### Practice consulting & MSOs

- **Typical MSO / practice-management fee:** 5% – 15% of net collections
  - Source: AMA Physician Practice Benchmark Survey (2024) — https://www.ama-assn.org/about/research/physician-practice-benchmark-survey
- **Typical practice-consultant day rate:** $1,500 – $3,500 / day
  - Source: MGMA consulting rate survey (2024) — https://www.mgma.com/data

### Independent practice economics

- **US physicians employed by hospitals or corporate entities rather than in independent practice:** ≈ 77.6% (hospital- or corporate-employed)
  - Source: PAI / Avalere Health — Physician Employment Trends Study 2019–2023 (2024) — https://www.physiciansadvocacyinstitute.org/PAI-Research/PhysicianEmploymentReport
  - Notes: Cited to underline why independent-practice-specific vendor guidance is scarce online — most content is written for hospital- or corporate-employed physicians. Figure reflects PAI/Avalere's 2024 report on 2023 data.
- **Share of US physicians in practices of 10 or fewer physicians:** ≈ 42%
  - Source: AMA Physician Practice Benchmark Survey (2024) — https://www.ama-assn.org/about/research/physician-practice-benchmark-survey
- **Physicians reporting EHR documentation as a leading burnout driver:** ≈ 60%
  - Source: AMA + Mayo Clinic burnout research (2022) — https://www.mayoclinicproceedings.org/article/S0025-6196(21)00522-6/fulltext

---

## Benchmarks library

URL: /benchmarks · Last reviewed 2026-07-23

### Medical Billing & Revenue Cycle

Operating benchmarks independent practices should compare any billing vendor against.

| Metric | Benchmark | Context | Source |
| --- | --- | --- | --- |
| Cost of collection (independent physician practices) | 6% – 12% of net collections | Fully loaded internal cost — salaries, benefits, PM/clearinghouse fees, and allocated overhead. Break-even benchmark for outsourced quotes. | MGMA DataDive Cost & Revenue (2024) — https://www.mgma.com/data |
| Outsourced RCM percentage fee (small practice) | 4% – 9% of net collections | Range varies by specialty, reimbursement profile, and claim volume. Exclusions (patient billing, self-pay) materially change effective rate. | HFMA / MGMA industry surveys (2024) — https://www.hfma.org/topics/map-keys/ |
| First-pass claim acceptance (target) | ≥ 95% | HFMA MAP Key; industry-standard threshold for a competent billing operation across most specialties. | HFMA MAP Keys (2024) — https://www.hfma.org/topics/map-keys/ |
| Net collection rate (target) | ≥ 95% of contracted allowables | HFMA MAP Key. Anything below 93% signals payer contract, denial, or write-off leakage. | HFMA MAP Keys (2024) — https://www.hfma.org/topics/map-keys/ |
| Days in accounts receivable (most specialties) | ≤ 35 days | Benchmark for well-run outpatient practices; specialties with heavy authorization or workers' comp trend higher. | MGMA DataDive Performance & Practices (2024) — https://www.mgma.com/data |
| Initial denial rate (industry average) | 6% – 13% of claims | Change Healthcare Revenue Cycle Denials Index — the widely cited primary source for denial-rate ranges by service line. | Change Healthcare Denials Index (2023) — https://www.changehealthcare.com/insights/denials-index |
| Medicare timely-filing limit | 12 months from date of service | Set in the Medicare Claims Processing Manual; commercial payer limits are typically 90–180 days and vary by contract. | CMS Claims Processing Manual (IOM 100-04) (2024) — https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs |

### Credentialing & Payer Enrollment

Timelines and standards to expect from any credentialing vendor or in-house team.

| Metric | Benchmark | Context | Source |
| --- | --- | --- | --- |
| Medicare (PECOS) enrollment — typical processing | 45 – 90 days | Retroactive billing generally permitted back to the effective date once approved. Site visits can extend timelines. | CMS Provider Enrollment (PECOS) (2024) — https://pecos.cms.hhs.gov/ |
| Commercial payer paneling — typical processing | 60 – 120 days | Ranges by state, payer, and network status (open vs closed). Closed panels can extend indefinitely or require an appeal. | NCQA Credentialing Standards (2024) — https://www.ncqa.org/programs/health-plans/credentialing/ |
| CAQH ProView re-attestation cadence | Every 120 days | Failure to re-attest silently invalidates the profile with downstream payers who source data from CAQH. | CAQH ProView (2024) — https://proview.caqh.org/ |
| Primary source verification standard | Required for education, licensure, DEA, board, malpractice | NCQA and Joint Commission standards for credentials verification organizations (CVOs) and delegated credentialing. | NCQA Credentialing Standards (2024) — https://www.ncqa.org/programs/health-plans/credentialing/ |
| Credentialing service pricing — per provider, per payer | $150 – $300 | Typical à la carte pricing. Bundled packages for a new provider across 8–15 payers commonly run $1,500 – $3,500. | Industry survey of independent credentialing vendors (2024) — https://www.mgma.com/topics/credentialing-enrollment |

### EHR & Practice Software

Adoption, cost, and interoperability benchmarks for EHR and practice management decisions.

| Metric | Benchmark | Context | Source |
| --- | --- | --- | --- |
| Office-based physicians using any EHR | ≈ 88% | ONC/NEHRS: about 88% of office-based physicians report using an electronic health record; certified-EHR share tracks close to this figure and has been stable in the high 80s since 2019. | ONC Health IT — Office-based Physician EHR Adoption (2021 (most recent NEHRS release)) — https://www.healthit.gov/data/quickstats/office-based-physician-electronic-health-record-adoption |
| Small-practice EHR — per provider, per month | $300 – $800 | SaaS ambulatory EHRs for practices under 15 providers. Enterprise systems (Epic Community Connect, athenaOne Enterprise) price above this range. | KLAS Small Practice Ambulatory reports (2024) — https://klasresearch.com/ |
| EHR migration — typical elapsed time | 4 – 9 months | From signed contract to full go-live with historical data available. Data-conversion scope and specialty templates drive the range. | KLAS Perceptions of EHR Migrations (2024) — https://klasresearch.com/ |
| TEFCA / USCDI v3 — required interoperability baseline | USCDI v3 as of 2025 certification | ONC HTI-1 rule sets the certified-EHR interoperability floor; TEFCA adoption is the on-ramp to nationwide query-based exchange. | ONC HTI-1 Final Rule (2024) — https://www.healthit.gov/topic/laws-regulation-and-policy/health-data-technology-and-interoperability-certification-program |

### Ambient AI Medical Scribes

Emerging category — benchmarks are early. Cite ranges, not point estimates.

| Metric | Benchmark | Context | Source |
| --- | --- | --- | --- |
| Ambient scribe subscription — per provider, per month | $150 – $600 | Wide range across enterprise and small-practice tiers; often billed annually with volume discounts above 25 seats. | KLAS Ambient Speech Emerging report (2024) — https://klasresearch.com/ |
| Reported documentation-time reduction | ≈ 20% – 70% (self-reported) | Peer-reviewed and vendor studies show wide variance by specialty and workflow. Pre-implementation baseline capture is required to validate. | JAMA Network Open — ambient AI scribe evaluations (2024) — https://jamanetwork.com/journals/jamanetworkopen |
| HIPAA baseline for scribe vendors | BAA required; PHI handling in-scope for HIPAA Security Rule | Ambient audio + generated notes are PHI. Vendor must sign a Business Associate Agreement and document safeguards. | HHS OCR HIPAA Guidance (2024) — https://www.hhs.gov/hipaa/for-professionals/security/index.html |
| Responsible AI framework for health | CHAI Assurance Standards Guide | Coalition for Health AI publishes the leading multi-stakeholder standard for evaluating clinical AI, including ambient documentation. | Coalition for Health AI (CHAI) (2024) — https://chai.org/ |

### Practice Consulting & MSOs

Cost and structure benchmarks for practice-consulting and management-services engagements.

| Metric | Benchmark | Context | Source |
| --- | --- | --- | --- |
| Independent consultant — hourly | $200 – $500 per hour | Solo and small-firm consultants serving independent practices. Boutique healthcare firms trend higher; large firms use blended-team pricing. | MGMA consulting and advisory pricing surveys (2024) — https://www.mgma.com/ |
| Startup practice consulting — flat fee | $15,000 – $60,000 | Range for a full startup engagement: entity formation guidance, credentialing coordination, EHR/PM selection, staffing plan. | Industry survey of startup-practice consultants (2024) — https://www.mgma.com/ |
| MSO management fee — typical range | 4% – 8% of net collections | Depends on scope (back-office only vs full clinical + non-clinical services). Corporate Practice of Medicine restrictions shape structure by state. | American Medical Association MSO guidance (2024) — https://www.ama-assn.org/practice-management/private-practices |
| OIG anti-kickback — safe-harbor compliance | Required for any risk-based or referral-adjacent MSO structure | Federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b) and OIG advisory opinions govern permissible MSO and management-services arrangements. | HHS Office of Inspector General (2024) — https://oig.hhs.gov/compliance/ |

---

## Glossary

URL: /glossary

### Revenue Cycle Management (RCM)
Revenue cycle management covers the full arc from patient scheduling and eligibility verification through coding, claim submission, payment posting, denials work, and final patient collection. Medical billing is a narrower subset focused on claim submission and payment posting. When comparing vendors, always confirm which segments of the cycle are inside the scope of work — 'RCM' as a label is not a specification.
Also known as: RCM, revenue cycle

### First-Pass Claim Acceptance Rate
First-pass claim acceptance rate measures the share of submitted claims that clear payer edits without rework on first submission. For most specialties, 95% or higher is the mark of a competent billing operation. Below 90% signals rushed submission, weak claim scrubbing, or credentialing gaps that are producing avoidable denials.

### Days in Accounts Receivable (Days in AR)
Days in AR is calculated as total accounts receivable divided by average daily charges. It is the single best summary metric for how quickly a billing operation is converting services into cash. For most specialties, days in AR trending under 35 is healthy; consistently above 45 signals a denials, follow-up, or credentialing problem worth investigating.

### Percentage-of-Collections Pricing
Under percentage-of-collections pricing, the billing vendor takes a defined percentage of what they actually collect for the practice, aligning incentives on collections but often penalizing high-reimbursement specialties. Always confirm which claims are excluded (self-pay, patient balances, small balances, appeals) before comparing headline rates.

### Clearinghouse
A clearinghouse translates and validates electronic claims between the practice management system and hundreds of individual payers. Ownership of the clearinghouse account is a contractual issue — the practice, not the billing vendor, should own it so that switching vendors does not require rebuilding payer connections from scratch.

### CAQH ProView
CAQH ProView is a single provider-maintained credentialing profile that most commercial payers pull from during initial credentialing and re-credentialing. The provider (or their credentialing service, working inside the provider's account) must re-attest every 120 days or payers may silently pull the profile and disrupt claims.
Also known as: CAQH

### PECOS
PECOS is the CMS system through which providers enroll in Medicare, add practice locations, and complete revalidation. Enrollment credentials should stay with the practice, not the billing or credentialing vendor. Medicare enrollment via PECOS typically takes 45–90 days.

### Payer Enrollment
Payer enrollment is the process of contracting with a specific payer so the provider is in-network and can be reimbursed under that payer's fee schedule. It is distinct from credentialing, which verifies identity, licensure, education, and history. A good credentialing vendor is explicit about which they do, which they hand off, and which payers are closed panels in your area.

### Closed Panel
A closed panel means the payer has determined they have sufficient network capacity in that specialty and geography and is not accepting new provider applications. No vendor can conjure enrollment into a closed panel — any credentialing service that promises to is misrepresenting. Check panel status before spending on an application.

### EHR (Electronic Health Record)
An electronic health record (EHR, sometimes called an EMR) is the system of record for clinical documentation, orders, results, and patient chart data. Most ambulatory vendors bundle EHR with a practice management (PM) module for scheduling, eligibility, and billing. Selection weighs specialty fit, usability, interoperability, and 3-year total cost of ownership more than headline monthly rate.
Also known as: EMR, electronic medical record

### ONC Certified Health IT
ONC certification signals that an EHR product meets federal criteria for interoperability, security, and quality reporting. Certification is verifiable on the CHPL registry. For practices participating in Medicare quality programs, ONC-certified EHR is typically required — confirm the specific certification edition matches the program you participate in.

### Ambient AI Scribe
An ambient AI scribe captures the audio of a clinical encounter, transcribes it, and drafts a structured note (typically SOAP or specialty template) for clinician review and sign-off. Evaluation weighs specialty accuracy, EHR integration depth, patient-consent workflow, and transparency of the underlying model — see the AI scribe rubric for the full criteria set.

### Business Associate Agreement (BAA)
A Business Associate Agreement is required under HIPAA any time a vendor creates, receives, maintains, or transmits protected health information on behalf of a covered entity. Every billing vendor, credentialing service, EHR vendor, AI scribe, and cloud provider touching PHI must sign one. No BAA is a hard walk-away.

### SOC 2 Type II
SOC 2 Type II is an independent audit report covering security, availability, and confidentiality controls tested over a defined period (typically 6–12 months). It is a common baseline expectation for vendors handling PHI alongside a signed BAA. Ask for the current report under NDA — a public marketing badge is not the same as the report.

### Management Services Organization (MSO)
A management services organization provides administrative infrastructure — billing, HR, IT, payer contracting, sometimes real estate — to independent practices. Structures range from pure fee-for-service to friendly-PC arrangements involving equity. Stark Law and anti-kickback compliance, exit terms, and clinical autonomy are the primary evaluation axes.

### Cost of Collection
Cost of collection is the fully loaded cost of running billing — salaries, benefits, software, clearinghouse fees, allocated overhead — divided by net collections. Most independent practices land between 6% and 12%. Calculating this before shopping vendors is the only way to fairly compare an outsourced percentage-of-collections quote.


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Attribution: cite as *The Practice Vendor Review — <page title>* with a link to the specific URL. For numeric claims also cite the underlying primary source listed above. CC BY 4.0.