🏥 Therapy Practice Workflow Analysis

Normal Flow: Standard process step
Pain Point: Problem area needing attention
System: Software platform or tool
Uncertainty: Area needing verification
1
Lead Sources
The practice acquires new client leads through several channels: Zocdoc, a third-party booking platform; the company's official website via Google Ads campaigns and organic search outreach; and an interactive chat feature embedded on the website.
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⚠
Broken Lead Capture
Major Issues:
• Website → Zoho: Integration is unreliable, described as "glitchy" and prone to "keeps dropping," requiring ongoing maintenance from a web developer.
• Zocdoc → Zoho: Leads frequently require manual transcription into Zoho CRM when automated integrations fail or are absent.
• Chat → Zoho: Outside business hours, chat defaults to a contact form, requiring manual follow-up.
↓
Z
Zoho CRM - Lead Processing
Zoho CRM serves as the primary system for tracking all incoming leads and managing the progression of potential clients through the sales funnel. The intake team guides them through stages like verifying insurance coverage, scheduling an initial evaluation, and assigning a therapist.
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⚠
Manual Eligibility Checks
Time-consuming process:
• Upon intake, insurance verification is performed manually by accessing various insurance company portals to confirm eligibility and benefits.
• Screenshots are uploaded into Therapy Appointment for billing reference.
• Aron confirmed this is a manual process, with interest in integrating an eligibility checking system.
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⚠
Calendar Sync Nightmare
Critical Issue:
• One-way sync between Therapy Appointment and Google Calendar: updates in Therapy Appointment reflect in Google Calendar, but changes in Google Calendar do not update Therapy Appointment.
• This leads to double bookings and scheduling conflicts, costing "thousands of dollars" in lost clients.
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⚠
High No-Show Rates
Reminder System Issues:
• High incidence of no-shows for initial evaluations due to limited reminder capabilities in Therapy Appointment.
• Zoho's mass texting is hampered by poor data flow from Therapy Appointment, leading to manual texting by the intake team.
1
Session Attendance
Client attends evaluation/session or no-shows/cancels.
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TA
Therapy Appointment - Documentation
Therapy Appointment is utilized for the creation and maintenance of client charts, excelling in the LSW supervision model where notes are routed to supervisors for review, sendback, or sign-off.
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⚠
Manual Follow-up Process
No-Show/Cancellation Management:
• Intake team manually manages rescheduling, confirmations, and follow-ups for no-shows.
• Significant "matchmaking back and forth" required to coordinate schedules and resolve issues.
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⚠
Poor Reporting & Analytics
Data Analysis Challenges:
• Therapy Appointment's poor reporting capabilities hinder extraction of metrics like customer retention.
• Data silos between systems limit effective analytics and strategic decision-making.
TA
Completed Session Notes
Therapy Appointment tracks charges and records payments, integrating with a clearinghouse for claims submission.
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1
Claims Processing and Submission
Billing team processes claims in large batches and submits them via Therapy Appointment to the clearinghouse and payers like Medicaid and Medicare.
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2
EOBs/Payments/Denials
Responses from insurance companies, including payments and denials, are received and reviewed in Therapy Appointment.
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⚠
Payment Processing Challenges
Payment posting may involve some automation for simple cases, but identifying and initial handling of denials and exceptions require significant manual effort, including reviewing PDFs and reports.
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Denial Management
Resolving denials involves significant "investigator work," including lengthy calls to insurers.
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Reporting Limitations
Reporting limitations in Therapy Appointment prevent filtering by payer, complicating follow-up efforts for denials.
1
Therapist Recruitment
The practice employs approximately 40 therapists, with additional onboarding, including full-time and part-time staff.
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⚠
Credentialing Bottleneck
Major Scaling Issue:
• Medicaid credentialing takes 4-6 months, identified as the "biggest impediment to growing fast."
• Errors in applications can restart the process, further delaying onboarding.
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⚠
Complex Payroll Calculation
Manual Payroll Process:
• Therapists are paid different rates based on session types, making payroll calculation complex and potentially error-prone.
• Relies on manual data extraction from Therapy Appointment.
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⚠
Caseload Management Issues
Balancing Challenges:
• No systematic method to balance caseloads, with full-time therapists targeting 20 hours of sessions weekly.
• Manual coordination across systems affects efficiency.
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?
Areas Needing Verification
Questions to Clarify:
• Exact Zoho ↔ TA update process
• Cancellation/no-show notification workflow
• Zocdoc integration details
• Marketing data flow and ROI tracking
• Payroll data extraction specifics

📊 Key Performance Metrics

Unreliable
Website Lead Sync Failure Rate
High
Initial Eval No-Show Rate
"Thousands"
Double Bookings Revenue Loss
4-6 mo
Medicaid Credentialing Time

⏱️ Daily Time Allocation Analysis

Staff Time Spent on Manual Processes (Hours/Day)
Lead Data Entry
"Tremendous"
Scheduling Conflicts
Significant
Payment Reconciliation
Substantial
Rescheduling Outreach
Notable
Total Manual Work: Considerable staff time across all processes

🔄 Lead Flow Integration Map

Website
❌→
Glitchy Sync
→
Zoho CRM
Zocdoc
❌→
Manual Entry
→
Zoho CRM
Chat
❌→
Manual Follow-up
→
Zoho CRM

💰 Revenue Impact Analysis

Monthly Revenue Loss from Operational Issues
Notable
No-Show Revenue Loss
Potential
Missed Billing Codes
"Thousands"
Lost Leads
Significant
Total Monthly Impact

👥 Therapist Utilization & Caseload

Current vs Target Therapist Metrics

Caseload Distribution

Target Range
20 hrs/wk
Actual Range
Variable

Utilization Rates

Target Utilization
Optimal
Actual Range
Unbalanced

🔧 System Integration Status

Current Integration Health Score

Zoho CRM ↔ Therapy Appointment

15% - Manual sync only

Google Calendar ↔ Therapy Appointment

50% - One-way sync only

Zocdoc ↔ Practice Systems

0% - No integration

Website ↔ Zoho CRM

70% - Unreliable sync

📋 Billing Cycle Efficiency

Claims Processing Timeline & Issues
Session Complete
→
Review & Batch
→
Submit Claims
→
Manual Reconciliation
Denial Investigation
Time-consuming calls to insurers
Limited reporting capabilities

🖥️ Software Systems & Platforms

TA
Therapy Appointment
Practice Management System
Serves as the EHR and Practice Management System, described as "archaic" with significant limitations.
Core Functions:
  • Client scheduling & calendar management
  • Electronic health records (EHR)
  • Billing and claims submission
  • Clinical documentation
  • LSW supervision workflow
Major Limitations:
  • No open API
  • Poor reporting capabilities
  • One-way calendar sync with Google Calendar
  • Non-customizable reminders
  • Difficult data manipulation
Z
Zoho CRM
Customer Relationship Management
Used for lead management and tracking the sales funnel, with problematic integration issues.
Core Functions:
  • Lead capture and management
  • Sales funnel tracking
  • Mass texting capability
Integration Issues:
  • Unreliable website integration
  • No effective communication with Therapy Appointment
  • Manual lead entry from Zocdoc and chat
📅
Google Calendar
Therapist Scheduling
Utilized by therapists for managing schedules, with problematic synchronization issues.
Usage:
  • Therapist personal scheduling
  • Availability management
Sync Problems:
  • One-way sync from Therapy Appointment
  • Leads to scheduling conflicts
🏥
Zocdoc
Online Booking Platform
A key source for generating client leads, requiring manual data entry due to lack of integration.
Functions:
  • Lead generation
  • Appointment booking
Integration Gaps:
  • No direct integration with Zoho or Therapy Appointment
  • Relies on Google Calendar sync
💳
Clearinghouse
Claims Processing Intermediary
Interfaces with insurance payers for claims submission and payment processing via Therapy Appointment.
Process:
  • Receives claims from Therapy Appointment
  • Forwards to payers
  • Returns payments and denials
🌐
External Payer Portals
Insurance Company Websites
Used for manual insurance eligibility verification and claims status checks.
Common Portals:
  • Medicaid portals
  • Medicare and commercial insurers
Pain Points:
  • Manual access required
  • Time-consuming process

👥 Key Personnel & Roles

S
Sarah
Operations Staff
Involved in operational processes, including intake and client management.
Key Responsibilities:
  • Lead intake processing
  • Client communication
  • Payroll calculation
Pain Points Reported:
  • Manual data entry
  • Poor reporting capabilities
A
Aron
Founder and Manager
Oversees strategic decisions, therapist management, and billing operations.
Key Responsibilities:
  • Therapist recruitment
  • Billing oversight
  • Scaling strategy
Major Challenges:
  • Credentialing delays
  • Denial management
📞
Intake Team
Lead Processing & Client Services
Manages leads, insurance verification, scheduling, and client communication.
Daily Tasks:
  • Lead entry in Zoho CRM
  • Manual eligibility checks
  • Appointment scheduling
  • Follow-ups
💰
Billing Team
Revenue Cycle Management
Handles claims submission, payment posting, and denial management.
Core Functions:
  • Claims batching
  • Payment reconciliation
  • Denial investigation