Practice profile
- Providers
- 5–15 (physicians, APPs, sometimes therapists)
- Specialty
- Multi-specialty primary care + specialty (cardio, ortho, GI, etc.)
- Payer mix
- Broad commercial + Medicare + Medicaid; 3–8 major payer contracts
- Monthly encounters
- 2,500–8,000
- Typical revenue
- $3M–$15M net collections/year
- Staff model
- Practice manager, front desk (2–4), MAs (per provider), 1–2 billers, dedicated credentialing at ~8 providers
The four decisions that matter most
Decision
EHR strategy
Recommendation: Specialty-configurable EHR with strong reporting and open FHIR API
Why: You need role-based templates by specialty, a real reporting layer (not exports to Excel), and API access for downstream analytics. The 'lightweight cloud EHR' category runs out of room around 8 providers.
Decision
Billing structure
Recommendation: In-house billing manager + outsourced coding audit + specialty coding for surgical lines
Why: At $5M+ collections, an in-house biller pays for itself, but coding expertise for surgical CPTs is worth paying for separately.
Decision
Credentialing
Recommendation: Dedicated internal credentialing coordinator once you cross 8 providers
Why: The math flips: ~$65K FTE is cheaper than $250–$400 per-provider-per-month outsourced fees once you're maintaining 8+ providers across 5+ payers.
Decision
AI scribe rollout
Recommendation: Multi-vendor pilot (2 vendors × 2 specialties) before enterprise selection
Why: Ambient scribe accuracy varies dramatically by specialty. What works for primary care may fail for orthopedic surgery consults. A structured 60-day pilot is worth ~$8K and prevents a six-figure mistake.
Recommended vendor stack
Each recommendation links to the relevant buyer guide for deeper criteria.
| Category | Recommendation | Why it fits | Budget |
|---|---|---|---|
| EHR | Specialty-configurable ambulatory EHR with FHIR API, role-based templates, and native reporting/BI | The reporting layer is what you'll live in as you grow. Do a real BI test in the demo — not a canned dashboard tour. | $600–$1,200 / provider / month + interface fees |
| Billing & RCM | Hybrid: internal billing manager + specialty coding contractor + quarterly external RCM audit | Preserves control and margin at scale, while buying expertise where it's rare (surgical coding, high-denial payer workflows). | 3.5–5.5% of net collections all-in |
| Credentialing | Internal coordinator once past 8 providers; delegated credentialing agreements with top 2 payers | Delegated credentialing agreements cut new-provider revenue lag from 120+ days to 30–60 days — a huge unlock at scale. | $65K–$85K FTE + software |
| AI Scribes | Enterprise-grade ambient scribe with per-specialty templates, deployed after 60-day structured pilot | You're now buying admin control, audit logs, and specialty accuracy — not just transcription. | $200–$400 / provider / month at scale |
| Consulting | Fractional CFO or practice-management consultant on 5–10 hours/month retainer + specialty coding audits | Ongoing financial and operational discipline pays for itself many times over at this size. Avoid all-in-one 'growth' consultants without domain credentials. | $4,000–$10,000 / month retainer |
Approx. total: 9–15% of net collections in total vendor spend once mature; higher during EHR migration years.
First-year buying playbook
Q1
Baseline audit. External coding audit and KPI baseline (denial rate, days-in-AR, per-provider net collections, no-show rate).
Q2
EHR + reporting layer. EHR reporting scorecard live with weekly automated distribution to physician owners.
Q3
AI scribe pilot → enterprise. Structured multi-vendor pilot completed; enterprise contract negotiated with volume discount.
Q4
Payer renegotiation. Top 2 commercial payer contracts renegotiated using MGMA benchmark data + your own case-mix report.
Vendor red flags for this archetype
- EHR vendors that quote 'call for pricing' after a 4-week sales cycle. Push for line-item pricing before demo #3.
- Billing vendors that resist quarterly external audits.
- AI scribe vendors without documented BAA and audit-log evidence.
- Consultants who lead with an MSO/PE roll-up pitch instead of an operating diagnostic.
- Credentialing vendors that won't let you download your own CAQH and PECOS records.
Common mistakes
- Choosing an EHR based on the loudest specialist's preference instead of the reporting/BI capability the group needs.
- Waiting too long to hire an internal credentialing coordinator — every day a new provider isn't enrolled is lost revenue.
- Layering three consultants (MSO advisor + growth coach + fractional CFO) with overlapping scopes.
- Signing enterprise vendor contracts without termination-for-convenience clauses and data-export SLAs.
When to revisit this stack
- Every acquisition or provider hire beyond 12 — vendor economics shift again around 15–20.
- Any quarter where per-provider net collections drop >10% vs trailing 4-quarter median.
- When a payer contract expiration falls within 6 months.