Introduction:
Over the course of the summer, I worked on a new startup at Fulcrum GT's startup program. During this time, we built Practility, an AI-powered platform that simplifies insurance compliance for small therapist practices. After several pivots informed by user research, we landed on the insight that claims could be created directly from guided progress notes, combining AI-assisted documentation, automated CPT coding, and a centralized dashboard into one streamlined workflow.
3 months (and counting)
Results:
12
hours saved each month with our AI-powered progress notes for therapists, based on initial user testing
The Problem:
Therapists dealing with insurance face high denial rates, tedious documentation, and no cheap solutions.
Therapists & Insurance→
Therapists don’t go into the field to do paperwork, yet in behavioral health, they spend 8–9 hours a week battling claims, CPT codes, and denials, with over 34% rejected/denied outright. For small practices, the choice was either struggle through confusing claims or pay costly coders, leading many to stop accepting insurance altogether. Additionally, documentation adds another heavy burden: therapists must write detailed progress notes after every session, a process that eats into client time and can lead to revoked payments ("clawbacks") if done incorrectly.
Our Initial Problem Framing→
At first, we didn’t set out to solve this problem for therapists; we began by exploring medical bill scanning tools for patients. But user feedback showed that fighting billing errors was unrealistic for patients, which led us to pivot to therapists' pain points.
Our Solution:
A comprehensive claims and document management software program for therapists.
Clear Claim management→
A centralized dashboard for ease of access to our documentation and claims-filing features
Reminders to file claims based on appointment schedules
Progress towards claim filing and documentation goals
Quicker and More Comprehensive Documentation→
Using our AI-progress notes feature ("practinotes"), users can save time manually writing out notes and instead can simply click through
Our feature also ensures that essential sections are not forgotten to reduce failed insurance audits.
We also customize the available tags based on the client's diagnosis.
Cleaner and Quicker Claim Filing→
Mostly autofilled insurance claims forms from our electronic health record
Human-AI teaming for CPT coding to reduce therapist cognitive load of choosing from over 10,000 coding options
Research:
What We Heard: Therapists Struggle with Time, Complexity, and Costly Billers
User interviews (11) →
Our Findings:
Admin work stole valuable client time.
Coding rules felt opaque and, therefore, led to denied claims.
Denials and rejections undermined financial stability.
“I’ve spent nine hours fighting Blue Cross Blue Shield on one denial, and it’s still unresolved." - Interviewee
Initial MVP Design Journey:
Digging into billing complexity to design therapist-friendly solutions.
Initial Planning and Ideation →
After my research, I began mapping the user flow to ensure all necessary information from insurance claims was covered in the screens. My biggest challenge was integrating the complex information from claim forms into a therapist-friendly flow. I drew on my research and additional secondary sources to create a streamlined user flow that addressed key therapist pain points.
Wireframing & Lo-fis →
The Wire-framing stage was where I mapped out where all of the information in the insurance claim form would go, since we wanted our system to speed up the process of filling in the form by auto-populating fields. My main goal at this stage was to include all of the information inputs in a way that wouldn't be overwhelming to users and also intuitive to them.
Adding The Progress Notes feature →
As we designed and researched, we realized the best way to auto-populate insurance claims with CPT codes was through progress notes, which therapists already complete after each session. This expanded our scope to include documentation, addressing even more pain points. To make the process efficient, I added preselected options and customized them by client diagnosis, reducing decision paralysis for therapists.
Iteration and Initial User Testing:
Expanding the Scope of Our Product and Refining Progress Notes
A More Comprehensive Platform →
As we learned more through talking with therapists and doing secondary research, we discovered that therapists would only use our platform if it were a full EHR system that had the same functionality as some of our competitors, such as Simple Practice or Therapy Notes. Therefore, we had to build all of the basic functionality that a therapist might need into our system, including functionality for treatment plans, Intake assessments, etc.
Adjustments to Progress Notes →
As we dug deeper into progress notes through user interviews, we realized our design needed to align with a standard framework, ultimately choosing BIRP for its Medicaid compliance. To make the notes more complete, I added additional sections and built a database of over 1,000 tag options that therapists could choose from. These tags can be adjusted for extremity (as shown), giving therapists more variety in their notes and reducing the risk of failing insurance audits.
Adjustments to Progress Notes LLM Generation Page →
Once the backend LLM was connected to the front end, we found that streaming the generated text on screen was far more effective than a static loading animation, as it reassured users that progress was being made. We also added a regeneration feature, allowing therapists to instantly reword notes from the same prompt if the initial output didn’t meet their needs.
Reflection and Next Steps:
In complex spaces like healthcare billing, design isn’t just about reducing frustration; it’s a safeguard against costly mistakes and lost revenue.
What I learned→
Designing for healthcare billing is about trust as much as speed.
Pivoting early concepts through research was critical to finding the right problem.
Collaboration across design, engineering, and business ensured compliance, revenue, and usability aligned.
Next Steps →
We plan to test the validity of our progress notes outputs with health insurance auditors to find areas where our notes may be lacking
We also plan to get more feedback from therapists to validate that the predefined options in progress notes are easily understandable and occur frequently enough to be a selectable option for a specific client diagnosis
Finally, we plan to get HIPAA audited to launch and add more practice management features like client therapist communication portal to complete with competitors like Simple Practice and Therapy Notes
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