Medical and specialty clinics

From the signed note to the claim to the payment, with denials and underpayments flagged.

For medical and specialty clinics. Fintra works beside Epic, athenahealth, eClinicalWorks or NextGen, or runs the practice-management side.
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Note to cash worklist

Example figures
UnitedHealthcare: paid
$1,910
Aetna: denied
$1,240
BCBS: underpaid
$560
Cigna: paid
$730
AR days 32, denial rate 4.1%, first-pass yield 96% (illustrative)

Your EHR keeps the chart; the billing, the front desk and the cash are left to you.

  1. The note is a chore, and coding drifts from it

    Providers burn evenings finishing notes, and the note, the codes, and the claim live in three different places. Revenue leaks in the gap between what was documented and what actually got billed.

  2. The revenue cycle leaks

    Denied claims, missed prior auths, and underpayments against the payer contract quietly erase margin, and AR days climb while nobody owns the appeal.

  3. The phone goes unanswered

    Missed calls turn into no-shows and patients who book with the practice down the street. The front desk drowns in reschedules, balance questions, and the same FAQs all day.

  4. Patient balances age into bad debt

    High-deductible plans leave real patient responsibility. Without an estimate and a payment plan at check-in, that balance ages into a write-off or a collections agency.

  5. Prior auth and eligibility slow everything down

    Coverage checks and prior authorizations are chased by phone and portal, so a service goes out without an active auth and gets denied on the back end, and the front desk loses hours a day to hold music instead of patients.

  6. Every site is its own island

    A group runs a different chart of accounts, comp model, and front desk per location, so leadership stitches the numbers together in a spreadsheet and closes the month once per site instead of once for the whole group.

What Fintra does for medical

Fintra runs the money side of your practice. Connect it to Epic, athenahealth, eClinicalWorks or NextGen for the chart, or let Fintra replace the practice-management side and run scheduling, the front desk and billing itself. It keeps one loop on one ledger: a note the clinician signs is coded into a clean claim and collected as cash, with an AI front desk answering the phone throughout.

  • Integrate your EHR, or replace the PM side
  • Ambient scribe to signed note to cash
  • Single, multi-site & multi-specialty
  • HIPAA-minded, BAA-ready

Physician compensation

Example figures
Dr. Okafor, MD, $48/wRVU + quality bonus
$59,520
Dr. Lin, MD, 42% of collections
$57,960
Dr. Reyes, MD, guarantee yr 1, $22k/mo
$22,000 floor
Comp computed from connected charge & collections data: guarantees and quality bonuses applied, every pay-run release sealed.

Keep the EHR, or run the whole practice on Fintra.

Clinical documentation can stay in the EHR your providers know: Fintra listens to the encounter, drafts the note, and once a clinician signs it, owns everything downstream, the coding, the claim, the cash, and the front desk. Or, if the practice-management system is the thing everyone hates, Fintra can run scheduling, intake, and billing itself.

Stays in your EHR

Tebra, AdvancedMD, athenahealth, eClinicalWorks, NextGen, Epic

  • Charts & clinical history
  • Orders & e-prescribing
  • Encounters & charge capture

Read through the clinical connector, live for early customers.

Fintra runs

Finance, Trust and People, plus the two medical jobs below

  • Ambient scribe & signed notes
  • Note-to-cash revenue cycle
  • Patient payments & plans
  • AI front desk (voice & text)
  • Physician compensation
  • Accounting & consolidation
  • Payroll & bill pay
  • Governance & evidence

Prefer to leave Tebra? Fintra can run scheduling, patient intake and communications, statements, and the full back office as one system, so a practice tired of its PM system can consolidate onto one governed ledger and leave it behind.

From the signed note to the payment, with plans patients can afford.

Every clinic has accounting and payroll somewhere. What decides whether a practice is healthy is the closed loop from a signed note to posted cash, and whether the patient can pay their share. So Fintra builds both in, on one ledger, and monetizes on collections, not just seats.

Note-to-Cash Revenue Loop

The closed loop on one ledger

A signed note auto-codes to ICD-10 and CPT/E&M, eligibility and prior auth are checked, the claim is scrubbed clean and submitted, the ERA auto-posts, and denials become AI-drafted appeals. Payments are matched to the payer contract, so underpayments get flagged instead of written off.

  • Auto-code ICD-10 + CPT/E&M from the signed note
  • Eligibility, prior-auth & claim scrub before submission
  • ERA auto-posting & contract-rate underpayment detection
  • Denials grouped by reason with appeals auto-drafted

Patient Payments and Plans

Affordability, then collections

Give the patient a good-faith estimate before the visit, then turn what they owe into a plan they can keep: a soft-pull decision at check-in, the practice funded upfront, and the balance collected over time instead of aging into bad debt.

  • Good-faith estimates before the visit
  • Point-of-care soft-pull approval, no hard hit
  • Practice funded upfront, patient pays over time
  • Every charge & approval Trust-guarded & sealed

Patient payment plan

Example figures
Patient responsibility
$1,850
approved
soft pull
$154/mo
no hard credit hit
funded today
$1,795
Fewer balances to collections, practice paid upfront, Trust-guarded, every approval sealed

The same books, approvals and payroll checks, set up for medical

Finance

The back office your EHR was never meant to run.

Accounting for a single clinic or a multi-specialty group, budgeting and provider P&Ls, bill pay and payroll, with the medical pain solved: wRVU- and collections-based physician compensation with quality bonuses and call pay, computed from connected charge data and guarded before payroll runs. One entity runs end to end today; multi-site consolidation is on the roadmap.

Explore practice finance
  • Multi-specialty accounting; multi-site roll-up roadmap
  • wRVU / collections physician comp
  • Budgeting, provider P&Ls & FP&A
  • Payroll, AP & guarded bill pay

Trust

Every note, write-off, and refund: decided and sealed.

The places records and money drift in a clinic, a signed note, a contractual adjustment, a patient refund, a write-off, a payment-plan approval, each get a verdict grounded in your real books and payer contracts, and each becomes hash-chained, recomputable evidence. Governance is decide-and-prove; enforcement is staged.

See how actions are checked
  • Signed notes hash-chained & tamper-evident
  • Write-off / refund / adjustment checks
  • Recomputable, framework-mapped evidence
  • One trust score across people & AI agents

People

Physicians, staff, and AI agents on one org chart.

Hiring, credentialing, and retaining clinicians and front-office staff is brutal. The Workforce Graph puts every provider, staff role, and AI teammate on one chart, priced against the same P&L, with an AI recruiter and interviewer that are advisory, and a named human who always approves.

See people and payroll
  • Recruit & credential clinicians faster
  • Provider productivity & cost per visit
  • Front-desk & clinical staffing to demand
  • Humans + AI agents, trust-scored

The visit note is drafted for the clinician to sign, and it cannot change after signing.

Fintra listens to the encounter and drafts a structured SOAP note before the provider leaves the room. Nothing counts until a named clinician reviews and signs, and at signature the note becomes tamper-evident and immutable. Corrections are addenda, never silent edits.

Ambient capture to SOAP draft

The visit is transcribed and structured into subjective, objective, assessment, and plan, with the problem list, orders, and suggested codes attached, ready for review before the provider walks out. Speech-to-text is a pluggable provider seam.

Clinician signs, then it seals

Nothing is billable or final until a named clinician reviews and signs the note. At signature it is hash-chained and locked, so the clinical record and the bill derive from the exact same signed source.

Addenda, never silent edits

After signing, every change is an append-only addendum with author, timestamp, and reason. No one can quietly rewrite history, and the original note is always recoverable for an audit or a payer.

One governed ledger, no drift

The signed note is the single source the coding, the claim, and the payment all flow from, so the chart and the money can never fall out of sync the way they do across an EHR, a coder, and a biller.

From the signed note to a clean claim to posted cash.

This is the moat: a closed revenue cycle where the signed note is the source of the code, the code is the source of the claim, and the ERA posts back to the same ledger. Real RCM depth, not a billing hand-off.

Auto-coding from the signed note

The signed note suggests ICD-10 diagnoses and CPT/E&M levels with the supporting documentation flagged, so coding starts from what was actually documented. A provider or certified coder confirms before anything is billed.

Eligibility, prior auth & claim scrub

Eligibility, remaining benefits, and prior-auth status are verified up front through a design-partner seam, then a scrubber catches the denials that actually bite before submission: missing auth, NCCI edits, modifier gaps, and medical-necessity mismatches. Clean claims go out as an 837P through the clearinghouse seam, which is design-partner today.

Denial management that closes the loop

ERAs auto-post, denials are grouped by CARC and RARC reason and routed with AI-drafted appeals and the missing item attached, and payments below the contracted rate are flagged as underpayments instead of being written off.

AR days, payer mix & net collection

A live view of AR days, aging by payer, denial rate, first-pass yield, and net collection rate, so you can see which payer is the problem and where the money is stuck, down to the claim.

Patient responsibility to plan to paid

After insurance adjudicates, the remaining patient balance becomes a good-faith estimate, a point-of-care payment plan, and reconciled cash on the same ledger, instead of a statement that ages into bad debt.

The EHR runs the visit; Fintra follows each dollar to the books.

Tebra and AdvancedMD are where independent practices and billing companies live; Waystar is the enterprise RCM rail. Each documents the visit and touches the claim; none owns the posted dollar all the way onto a governed general ledger. That gap is Fintra.

vs Tebra (Kareo + PatientPop)

Replace

Tebra is the truest all-in-one for independent practices, and its worst reviews are billing and statement leakage. Fintra already out-guns its claim internals (837P + CMS-1500, NCCI/MUE scrub, 835 line-level auto-posting, contract-rate underpayment detection) and adds governed refund/write-off approvals and the closed signed-note, then code, then claim, then cash loop on one ledger. Tebra hands billing off; Fintra keeps it.

vs AdvancedMD (billing companies)

Replace

AdvancedMD’s best segment is billing companies, and its loudest complaint is billing-setup errors nobody could trace. Fintra’s answer is structural: a governed, recomputable, hash-chained claim + underpayment engine with named-human approvals, so mis-billing can’t hide. Multi-client and MSO mode, which that segment needs, is on the roadmap.

vs Waystar (enterprise RCM)

Integrate

Waystar is the clearinghouse + eligibility + denials rail Fintra rides. We carry the 837P through it and own everything after the remit: post the 835 to a governed ledger, seal every write-off and refund as recomputable evidence, and reconcile cash to books. Waystar optimizes the claim; it has no accounting, no close, no evidence graph. Coverage-detection / propensity-to-pay depth stays theirs.

Scheduler, portal & patient self-service

In build

A color-coded multi-provider scheduling calendar, patient self-booking, digital intake forms, two-way texting, and a patient portal: the daily surface Tebra and AdvancedMD lead with. In build alongside the AI front desk that already books, texts back, and takes payment; the claim engine and note-to-cash loop are live today.

An AI front desk answers calls, books visits and takes payments.

A voice and text front desk that never puts a patient on hold. It books and reschedules against the real calendar, texts back every missed call, collects balances, and answers the questions your staff repeats all day, with every action governed and posted to the same ledger.

Voice and text that books itself

Patients call or text to book, reschedule, or cancel; the AI front desk checks the live schedule, offers real open slots, and confirms, day or night, with no hold queue and no phone tag.

Missed-call text-back

Every missed call gets an instant text back so the patient books with you instead of the practice down the street. No lead is left on hold, and after-hours calls become morning appointments.

Collects copays and balances

The front desk can send a secure pay link, take a copay, or set up a payment plan, with every charge governed and posted to the same ledger. It never sees or stores raw card data; the payment rail is a pluggable seam.

Answers the FAQs, hands off the rest

Hours, directions, insurance accepted, prep and refill instructions, and records requests are handled or routed to the right queue. Anything clinical always hands off to a human on staff.

Built for HIPAA, with a BAA available and a record ready for an audit.

Every note signed and every dollar-moving action in the practice is decided against your real books and payer contracts, scored, and sealed as evidence you can hand an auditor, not a compliance binder you update once a year and hope holds up.

HIPAA, BAA & the audit trail

PHI is access-controlled and every read and write is logged to a tamper-evident audit trail. Fintra is built to operate under a Business Associate Agreement, and each subprocessor in the provider seam, transcription, clearinghouse, and payments, sits behind its own BAA.

Frameworks & controls, mapped once

HIPAA, HITECH, SOC 2, PCI-DSS for card and patient-plan payments, and patient-data DLP, 84 frameworks and 111 controls mapped a single time, so one governed action satisfies many at once. Adding a framework points at the same evidence instead of starting over.

Policies, attestations & training

Versioned policies with full change history, plus staff training and certification tracking: who acknowledged which policy, who is due for HIPAA re-training, and when. The attestation trail is part of the same evidence graph, not a separate spreadsheet.

AI Action Governance

Every note signature, refund, write-off, contractual adjustment, payment-plan approval, or access change gets a verdict and an Action Trust Score before it lands. Fintra Trust decides, records, and can gate the action; broader automatic enforcement is staged, so today it always decides and proves, and gates where it is wired in.

Recomputable agentic evidence

Each governed action is hash-chained and mapped to the controls it satisfies, so verify_chain() re-derives the whole chain from your data, tamper-evident and reproducible. Scoring is deterministic and explainable, never a black box; the source-system connectors remain design-partner.

Staffing, credentials and pay for a group with many providers.

A multi-specialty group runs on the people it can hire, credential, and pay correctly, and on the authorizations that keep its claims payable. Fintra puts all of it on the same governed ledger as the money.

Prior authorization, tracked to the claim

Prior auths are requested, tracked to expiration, and tied to the exact claim they protect, so a service never goes out the door without the auth that makes it payable, and expiring auths are flagged before the visit is booked.

Payroll for a multi-provider group

W-2 staff, 1099 locums, and physician partners on one payroll, with wRVU, collections, quality bonuses, and call pay computed from connected charge data and guarded before the run releases.

Credentialing & payer enrollment

Track each provider's licenses, DEA, board certifications, and payer enrollments with expiration alerts, so a lapsed credential never turns a full day of claims into denials.

Staffing to real demand

Staff the front desk and clinical roles against actual visit volume and provider templates, with humans and AI teammates on one workforce graph, priced against the same P&L.

Reminders and recalls that keep the schedule full.

Security keeps the money you already earned; growth brings in more of it. Fintra runs acquisition, recall, referrals, and provider incentives on the same books and the same governance, so a new patient becomes a paid, sealed visit without leaving the platform.

Patient acquisition & reactivation

Reactivate lapsed patients, fill open slots, and run recall for chronic-care and annual visits off your real charge data, targeted by who is due and what the visit is worth, not a blast to the whole panel.

Referrals & reputation

Track referring-physician relationships, member-get-member, and post-visit reviews, attributed to the encounters and collections they produced, so you invest in the referral sources that actually grow the panel.

Provider incentive comp, guarded

Physician incentives on collections and wRVU, quality bonuses, and call pay computed straight from connected charge data, with clawbacks on refunds and reversed collections, every run scored and sealed as evidence like any other pay run.

Referral to estimate to paid

A new referral becomes a good-faith estimate, a point-of-care payment-plan decision, and a funded, reconciled balance in one flow, one governed ledger from first contact to the sealed dollar, with no hand-off to a separate CRM.

Continuous controls for medical groups.

Fintra tests every transaction, not a sample; only the items that fail open an exception; each exception carries a sealed record of what was checked; the record is mapped to the SOX 404 control it tests; an auditor reviews it through time-limited access.

ControlHow it is checkedFrameworkStatus
Refund / write-off approvalTested continuously by the dual-approval test handler on every patient refund and payer-overpayment return over threshold.SOX-CA-02 · Dual approvalTested today
Supply-vendor bank-change reviewTested continuously by the vendor bank-detail change-review handler on supply and equipment vendors.SOX-CA-09 · Vendor bank-changeTested today
Revenue posting cutoffTested continuously by the period-cutoff handler: revenue posts in the period it was earned.SOX-CA-05 · Period cutoffTested today

Only the controls marked tested today run against your real transactions now. It works beside your GRC tool and your external audit, not instead of them.

How continuous testing works

Fintra for medical today

The Money, Trust, and People engines are the shipped Fintra platform, and the note-to-cash logic, governance, and evidence run on it. The pieces that touch the outside world are a pluggable provider seam, live for design partners and on the near-term roadmap, not a one-click integration for every practice yet: the EHR/PM connectors (Tebra, AdvancedMD, athenahealth, eClinicalWorks, NextGen, Epic) and the RCM rail (Waystar) it rides, the ambient speech-to-text and transcription, real-time eligibility and benefits verification, the clearinghouse that carries the 837P claim, and the patient-financing and payment rails, which simulate today so no real money moves. What is genuinely real: the 837P claim generator (with a printable CMS-1500), the NCCI/MUE clean-claim scrub, 270/271 eligibility, and 835/ERA line-level auto-posting into insurance-paid, contractual write-off, and patient responsibility. What is NOT built yet and is in active development: the scheduling calendar + patient self-booking, digital intake, the patient portal, telehealth, and reputation/reviews, the daily surface the SMB EHRs lead with, plus billing-company multi-client (MSO) mode. Auto-coding and note drafting are AI assistance that a named clinician or certified coder reviews and signs, never an unattended biller. Multi-site and multi-entity consolidation is on the roadmap: today Fintra runs a single practice entity per set of books. We will always tell you what is production-ready versus what we are building with you. In demos, no real money moves and no PHI is used.

Pages by role

One set of books runs the whole back office. These pages start from the job you do.

Bring one week of claims to a 15-minute demo.

Bring one clinic or your whole multi-specialty group. We'll show the ambient scribe, the note-to-cash loop, patient plans, the AI front desk, and the evidence trail on your specialty.

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