Practice profile
- Providers
- 1 MD/DO or NP + 1–2 support staff
- Specialty
- Family medicine, internal medicine, general pediatrics
- Payer mix
- 60–80% commercial + Medicare, minimal Medicaid
- Monthly encounters
- 300–500
- Typical revenue
- $450K–$900K net collections/year
- Staff model
- Physician, 1 MA, 1 front desk (often cross-trained)
The four decisions that matter most
Decision
In-house vs outsourced billing
Recommendation: Outsource, percent-of-collections
Why: A solo practice can't afford the fixed cost of a certified biller (~$55K+ loaded) unless collections exceed roughly $700K/year AND the physician wants to manage a biller. Below that threshold, an outsourced RCM at 6–9% of net collections is almost always cheaper and lower-risk.
Decision
Standalone EHR vs all-in-one
Recommendation: All-in-one (EHR + PM + patient portal + telehealth)
Why: Integration overhead sinks solo practices. A single vendor that covers scheduling, charting, e-prescribing, patient portal, and telehealth eliminates 3–4 vendor relationships and the interface fees that come with them.
Decision
Ambient AI scribe — yes or no
Recommendation: Yes, if EHR-integrated and priced under ~$300/provider/month
Why: For a solo doc, 60+ minutes/day back is worth ~$200/day of billable capacity or ~4,000 minutes/month of life. The math works at almost any credible scribe price; the risk is EHR integration friction, not the tool itself.
Decision
Credentialing — DIY, contract, or ongoing service
Recommendation: One-time contract for initial enrollment; DIY re-attestations
Why: Initial payer enrollment for one provider is 90–180 days of highly-templated work. Paying $2,500–$5,000 flat to a credentialing specialist for the initial slate is cheap insurance. Re-attestations every 3 years are calendar work a front desk can own.
Recommended vendor stack
Each recommendation links to the relevant buyer guide for deeper criteria.
| Category | Recommendation | Why it fits | Budget |
|---|---|---|---|
| Billing & RCM | Outsourced RCM, percent-of-collections (6–9%), with denials + patient statements included | Aligns the vendor's incentive with yours, avoids fixed labor cost, includes the boring but revenue-critical work most solo practices under-invest in. | 6–9% of net collections |
| EHR | All-in-one cloud EHR + PM + portal + telehealth, per-provider pricing, open API | One contract, one login, one support number. Verify data export terms in writing before you sign — this is where solo practices get trapped. | $500–$900 / provider / month |
| AI Scribes | EHR-native ambient scribe, deployed on shadow charts for 2 weeks before enterprise rollout | Integration is 80% of the value. A best-of-breed scribe that pastes into your EHR is worse than a merely-good scribe that writes into the note fields directly. | $150–$300 / provider / month |
| Credentialing | One-time initial enrollment package from a credentialing specialist; DIY CAQH maintenance | Predictable one-time cost beats an ongoing retainer for a stable single-provider practice. | $2,500–$5,000 one-time, then DIY |
| Consulting | None on retainer. Engage a fractional practice consultant only for MSO/PE evaluation or a specific ops overhaul. | Solo practices burn cash on generic consulting; they benefit from targeted 2–6 week engagements tied to a specific decision. | $0 baseline; $5K–$25K per targeted project |
Approx. total: $95K–$180K/year total vendor spend for a $650K-revenue solo practice (roughly 15–28% of net collections).
First-year buying playbook
Q1
EHR + billing baseline. EHR live with clean fee schedule loaded; RCM vendor onboarded with 30-day denial baseline captured.
Q2
Credentialing + payer contracts. All target payers enrolled or in-process; commercial contracts reviewed against MGMA median rates.
Q3
AI scribe pilot. Ambient scribe live on all encounters; documentation time measured vs pre-scribe baseline.
Q4
Optimize. Denial rate < 8%, days-in-AR < 40, physician charting time < 60 min/day, first payer contract renegotiation opened.
Vendor red flags for this archetype
- Any billing vendor that quotes a flat monthly fee without a per-claim or percent-of-collections comparison — you're likely being priced for their worst customer.
- EHR vendors that charge separately for the patient portal, telehealth, or e-prescribing. These are commodities in 2026.
- AI scribe vendors that can't name your EHR in the demo and show a real note flowing into it — 'integration coming Q3' is a red flag.
- Credentialing services that require a 12-month minimum for a solo, stable provider.
- Consultants who lead with an MSO/roll-up pitch on the first call.
Common mistakes
- Buying an enterprise-grade EHR designed for hospital-owned practices — you pay for governance and IT overhead you don't have.
- Paying for two overlapping tools (e.g., EHR-native messaging AND a separate patient engagement suite).
- Underestimating the credentialing timeline and starting to see patients before contracts are effective — the resulting write-offs dwarf any credentialing fee.
- Signing a 3-year EHR contract without a documented data export and off-boarding clause.
When to revisit this stack
- Adding a second provider — most all-in-one contracts have step pricing that penalizes growth.
- Payer mix shift of ≥10 percentage points — this changes the billing math.
- Two consecutive quarters with denial rate > 10% — the vendor may not be a fit.