Notes on running a practice.

Why notes pile up

Most therapists don't fall behind on notes because they write slowly. They fall behind because the note happens hours after the session, when the details have faded and the next client is already waiting. The fix is less about typing speed and more about when and how you write.

1. Write inside a structure, not from scratch

A SOAP note answers four questions: what the client reported, what you observed, what you make of it, and what happens next. Keep a template with those four headers and fill them in order. A blank page invites overthinking; a structure invites finishing.

2. Capture two lines right after the session

You don't need the full note immediately. You need the two details you will otherwise forget: the main theme and any risk or change. Two lines within five minutes of the session make the full note easier to complete later.

3. Book note time like a session

A recurring 30-minute block at the end of the day beats writing between sessions. Notes written in one sitting are also more consistent, which matters if they are ever reviewed.

4. Let the first draft be a draft

If your EHR can draft the note from the session, start from that draft and edit. In Eggmed, the AI note taker drafts a SOAP note during the session, with your client's consent, and you review it before signing. The clinical judgment stays yours; the typing mostly doesn't.

5. Sign the same day

An unsigned note is unfinished work that follows you home. Whatever routine you pick, make same-day signing the rule and late notes the exception.

Small habits, repeated daily, are what actually end the evening paperwork shift.

The billing cycle in one paragraph

Before the session, you check the client's coverage. After the session, you sign your note, and a claim goes to the payer through a clearinghouse. The payer responds with a payment and a remittance (an ERA) that explains what was paid and why. The remittance distinguishes payer payment, contractual adjustments and patient responsibility. Confirm the permitted patient balance before invoicing; an unpaid amount is not automatically owed by the client. That's the whole loop; most billing pain comes from one of these steps being skipped or done late.

Check eligibility before the session, not after

Coverage changes: plans lapse, deductibles reset, copays move. A quick eligibility check before the visit tells you the copay and the deductible left, so there are no surprises for you or the client. Modern EHRs can run this automatically a day or two before each appointment.

Clean claims get paid faster

A claim is "clean" when the codes, diagnosis, provider details and client details all agree. The usual rejects are avoidable: a CPT that doesn't match the session length, a missing diagnosis link, or the wrong rendering provider. A checklist before submission catches these in seconds; an appeal afterwards costs weeks.

Read your ERAs

The ERA is where you learn what a payer actually pays you. If it posts automatically into your EHR, look at the pattern monthly: repeated denials on one code or one payer usually have a single fixable cause.

Self-pay still needs paperwork

For uninsured or self-pay clients, follow the applicable Good Faith Estimate requirements, including requests and qualifying scheduled care. A superbill can support an out-of-network reimbursement request, but reimbursement depends on the plan. Review the CMS guidance on estimates.

If billing is the part of practice you dread, it's worth seeing how much of this loop can run on its own.

The fear is real, the risk is manageable

Changing your EHR mid-practice feels like changing engines mid-flight: client records, years of notes, a full calendar. But practices do it every week, and the ones that do it calmly follow the same few steps.

1. Export before you decide anything

Ask your current EHR which records, notes and attachments can be exported, and in which formats. Do a test export first so you know what you have and in what format. This is also your backup, whatever happens next.

2. Ask the new vendor who does the work

The single most useful question when evaluating a new system: "Who does the migration, you or me?" If the answer is a help article, budget your own weekends for it. If the vendor's team does it, ask what they move: records, notes, schedules, documents.

3. Run both systems side by side

Pick a switch date, but keep the old system in read-only mode for a while. New sessions go in the new system; the old one stays available for reference. This removes most of the risk and nearly all of the stress.

4. Move your clients gently

Clients need very little: a portal invitation by email and a way to book. Send it once, mention it in session, and give it two weeks.

5. Check, then let go

Spot-check a sample of charts in the new system against your export. Confirm the records and attachments are complete and readable, preserve the export securely, and review retention and access requirements before closing the old account.

At Eggmed, migration is handled by our team with scope and timing agreed around your records and practice. However you switch, the pattern above keeps it boring, and boring is exactly what you want.

No-shows are a systems problem

A missed session costs you the hour, the income, and often the momentum of the work itself. It's tempting to treat no-shows as a client problem. In practice, they respond better to systems than to frustration.

1. Remind more than once, in more than one channel

One email the day before is not a reminder system. A confirmation at booking, a reminder two days out, and a same-day text cover the three moments people actually forget. If your EHR supports reminder workflows, set them once and stop thinking about them.

2. Make rescheduling easier than cancelling

Most no-shows are not refusals; they are collisions with life. A booking link in the reminder lets a client move the session instead of skipping it. A moved session is a kept client.

3. Have a policy, in writing, signed early

A late-cancellation and no-show policy only works if the client agreed to it before the first miss. Collect the acknowledgment with the intake paperwork, and apply it kindly and consistently.

4. Track the pattern, not the incident

One miss is life. Three misses is a pattern worth a conversation, clinical or practical. Your EHR's attendance record makes the pattern visible; a distinction between cancelled and late-cancelled tells you which policy applies.

5. Look at your own calendar too

No-shows cluster around long gaps between booking and session, and around times clients chose under pressure. Shorter lead times and honest scheduling conversations quietly remove many misses before they happen.

Reminders, easy rescheduling and a signed policy are all built into Eggmed's client engagement tools, and none of them require you to chase anyone.

The problem is rarely the video

When telehealth attendance sags, the video quality is rarely the reason. Friction is: a link that arrives in the wrong place, an app to install, a login to remember, a client who isn't sure it's private. Remove the friction and attendance follows.

Send the link where the client already looks

The session link should arrive by text or email, close to session time, and open in a browser. Every extra step, an app store, an account, a password, loses someone. Look for a setup where the client taps once and lands in the session.

Say the privacy part out loud

Clients wonder whether video therapy is private, and most won't ask. One sentence in your intake and one on your booking page, saying sessions run on an encrypted, HIPAA-compliant platform, settles it for most people.

Keep an in-person feel

Small things carry the therapeutic frame across the screen: starting on time, a consistent background, looking at the camera when it matters, and closing the session as deliberately as you would in the room. Captions help clients who process better by reading; a good platform offers them live.

Have a plan B you never improvise

Technology fails occasionally. Agree the fallback with each client in advance: if the video drops, you call. Improvised fallbacks eat session time; agreed ones cost a minute.

Telehealth in Eggmed runs in the browser with a per-session link, live captions and screen sharing, so the technology stays out of the way of the work.

Your profile is a landing page

For many therapists, the Psychology Today profile brings in more first contacts than their own website. It deserves the same care: a clear photo, a first paragraph written to one person, and an easy next step.

Write to one reader

Directories reward specificity. "I help adults with anxiety that shows up at work" reaches someone; "I treat anxiety, depression, trauma and relationships" reaches no one in particular. Say who you help, with what, and what a first session feels like.

Lead with the first two sentences

Most visitors read the photo, the headline and two sentences. Put the person you help and the change they want in those two sentences, not your degrees. Credentials matter, but they belong below.

Make the next step tiny

The gap between "reading your profile" and "sitting in a session" is where clients are lost. A booking link that works without a login, or a response the same day, turns interest into a consult. If your EHR gives you a public booking page, put that link everywhere your name appears.

Keep it honestly current

Openings, fees, insurance, telehealth or in-person: when these are out of date, the wrong people write and the right ones don't. A five-minute review each month keeps the profile working.

We keep a longer, step-by-step version of this in our free Psychology Today profile guide.