fluence

ƒ(voice) = Note + Rx + CPT + Claim

EARLY ACCESSThe voice-first dermatology EMR

One flat $600 per provider per month for founding practices. Billing included.
No percentage of your collections. Staff seats are free.

One sentence does four jobs.

You say

“Inflammatory papulopustular acne on the face is worsening, so start dapsone 7.5% gel every morning and doxycycline 100 twice daily for 21 days.”

Note01
ASSESSMENT & PLAN
1. Acne vulgaris, inflammatory papulopustular, face. Worsening.
Start dapsone 7.5% gel every morning.
Start doxycycline 100 mg PO BID × 21 days.
Prescriptions02
Dapsone 7.5% gelApply a thin layer every morning
Doxycycline 100 mg capsule1 capsule by mouth twice daily × 21 days · Qty 42
Queued for your signature
Coding03
L70.0Acne vulgaris
99214Established patient, moderate complexity
Why 99214: a worsening chronic condition, plus prescription drug management.
Billing04
99214→ L70.0
  • Built from the same sentence
  • Coding edits checked
  • Diagnosis linked to every line
Claim ready to send

Example with a fictional established patient. You review and sign everything.

No clicking through templates, no one typing beside you in the room, and no billing company taking a cut.

Apply for a founding spot → See what you'd save Built by a board-certified dermatologist →

10 spots. Locked pricing for 24 months. A direct line to the founder.

Savings

What your current setup costs you.

Move the sliders to match your practice. Fluence is one flat price per provider: $600 a month for founding practices, billing included, no percentage of your collections. Staff seats are free. Standard price after the founding group: $750 per provider per month. Pay a year ahead and two months are free.

Dermatology billing typically runs 4–8% of collections. Set 0 if you bill in-house.
A human scribe, an AI scribe, or an MA who clicks and types for you. If they also room patients, count only the documenting share.
Your setup today, per year
With Fluence, per year
Fluence subscription, founding price
Denial follow-up, about 4 hours a week of your staff
Estimated yearly savings

Apply for a founding spot →

10 spots. Locked pricing for 24 months. A direct line to the founder.

Why it's different

Built around how dermatologists actually work.

Four places the old way costs you time, staff, and money, and what Fluence does instead.

Say what matters. Nothing else.

Ambient scribes transcribe the whole conversation, so the note fills with small talk you edit out later. An MA at the keyboard costs you a salary and pulls them away from rooming and procedures.

With Fluence you dictate only what belongs in the chart, and your MA does the work only they can do.

  • No transcript to clean up
  • No one typing beside you
  • Your staff back on patient care
Recorded in the room
"How was the trip?"
"Kids are doing great."
"It's gotten worse on my face."
"Traffic was awful today."
"Is that a new jacket?"
What Fluence charts
Acne vulgaris, face. Worsening. Start dapsone 7.5% gel every morning.
Documentation cost, per month
Scribe or MA~$2,000
Fluence$600
Example figures from the savings calculator above.

Your treatment plans, not a drug search.

No searching drug lists or clicking through order screens. Say the plan and Fluence pulls it from your own treatment algorithms, written the way you practice.

Prescribing is built in, so you sign and send it yourself. No one else has to push scripts.

  • Plans in your words
  • Read back before you sign
  • E-prescribing on the same screen
“Start my inflammatory acne plan.”
Your planInflammatory papulopustular acne
Dapsone 7.5% gel · thin layer every morning
Doxycycline 100 mg · twice daily × 21 days
Signed · sent to pharmacy

Codes and modifiers, straight from your sentence.

Procedures, diagnoses and the visit level come from what you say, each tied to the words that justify it, and flow straight into the claim.

Modifiers like 25 and 59 are applied when your documentation supports them. It never raises a code on its own.

  • Procedure and visit coded together
  • Modifiers applied with the reason shown
  • Nothing billed that you didn't say

“Shave biopsy of a pearly papule on the left cheek, and for his worsening acne, start doxycycline 100 twice daily for 21 days.”

11102Tangential (shave) biopsyD48.5
99214-25Separate visit, same dayL70.0
Modifier 25 applied: acne was a separate problem, managed the same day as the biopsy.

Billing in-house. People only where it takes a person.

Industry-wide, about 1 in 12 claims is denied the first time. MGMA reports 8% for single-specialty practices, and Experian reports 41% of providers now see more than 10% denied.

Fluence checks coding edits, modifiers and diagnosis links before a claim goes out. When a denial comes back, it links it to the visit, explains why, and prepares the corrected claim or appeal. Your staff step in only for the few that need a human.

Paid on first pass Denied, fix prepared by Fluence Needs your staff
Illustration of 100 claims at an 8% first-pass denial rate. The split between prepared fixes and staff work will vary by practice.
Vignesh Ramachandran, MD
Board-certified dermatologist Graduated #1, Baylor College of Medicine NYU Dermatology-trained 120+ peer-reviewed publications Alpha Omega Alpha Gold Humanism Honor Society

Built by a practicing physician and serial entrepreneur

I couldn't find an EMR I'd want to use. So I built one.

Seeing a high volume of patients taught me how much the EMR determines a clinic's productivity. Every extra click is a patient waiting.

What I had was the opposite: endless clicking, antiquated software, and someone typing beside me just to keep up.

I wanted a fresh take: maximum value, and AI used intelligently for efficiency, not as a gimmick.

Nothing out there was good enough that I'd want it for myself, so I built my own.

Vig
Vignesh Ramachandran, MDFounder, Fluence
Book 15 minutes with Vig →

Safety

It refuses to guess.

Software that bills for you has to be more careful than a person, not less.

Traceable

Every code traces to your sentence.

In an audit you can show exactly why each code was billed.

No upcoding

It never raises a code on its own.

You review and sign every code.

No guessing

Unknown stays visibly unknown.

Missing a lesion size or a site? It asks at read-back instead of filling one in.

Dermatology depth

Built for the whole specialty.

Biopsies, excisions and repairs, Mohs stages, pathology tracking, iPLEDGE, and your own treatment plans.

Low risk

Try it without switching.

Keep your current EMR running while you try Fluence on a handful of patients. Switch only when you trust it.

1

Run it side by side

Use Fluence for a few visits a day while your current system keeps running.

2

Compare the results

Check its notes, codes and claims against what you'd have done today.

3

Switch, or walk away

Move over when you're ready. If you leave, every record leaves with you.

Read our promise on data, privacy and AI →

Free guide

Opening a dermatology practice?

A step-by-step checklist from a practicing dermatologist: the 6-month timeline, credentialing, CLIA, pathology, procedure room and billing.

Get the free guide →

Questions

What physicians ask first.

How is this different from an ambient AI scribe?

An ambient scribe records the whole visit and hands you a draft to clean up and paste into your EMR. Fluence is the EMR.

You dictate only what belongs in the chart. That sentence becomes the note, the prescriptions queued for your signature, the codes, and the claim. Nothing is a draft you copy somewhere else.

It also refuses to guess. Missing a lesion size or a site? It asks at read-back instead of filling one in. You review and sign everything.

What happens to my biller?

Billing is included in the $600 per provider per month. Staff seats are included free. There is no per-seat charge for your team. No billing company, and no percentage of your collections.

$600 is the founding price. Standard price after the founding group: $750 per provider per month. Pay a year ahead and two months are free.

Fluence builds each claim from the signed note. It checks coding edits, modifiers and diagnosis links before the claim goes out. It posts payments from the payer's remittance and puts every denial on a worklist with its reason, linked to the visit. Your staff work only the denials that need a person.

Where it stands today: this billing workflow is built and tested with fictional patients against a clearinghouse test account. No real payer has paid a Fluence claim yet. A production clearinghouse account and payer enrollment come before the first live claim.

What does it cost for a PA or NP?

A PA or NP who prescribes under their own name is $450 per month. Staff who do not prescribe, including MAs, billers and front desk, are free.

Pay a year ahead and two months are free.

What does implementation look like?

New practices have nothing to move. If you're switching, we move your patients, appointments, medications, allergies and problem lists, and attach your past notes to each chart. We plan the move with you before you start.

Want to try it first? Keep your current EMR running. Try Fluence on a few visits a day, compare its notes, codes and claims with yours, and switch only when you trust it.

We set a start date with you on the call, and the founder sets Fluence up with you.

Founding practices get a direct line to the founder throughout.

Is my data safe?

Fluence is pre-production: no real patient data has ever been entered. It is built with these safeguards:

  • Hosting: AWS, under a signed BAA. Each practice's data is walled off at the database level.
  • Encryption: TLS for all traffic, plus field-level AES-256-GCM on direct identifiers such as name, date of birth, address and member ID. Documents and backups are stored encrypted.
  • Sign-in and access: passkey sign-in and role-based permissions, checked on every request. Only the signing physician can sign notes or prescribe.
  • Audit log: append-only. The database blocks edits and deletes.
  • Signed notes never change. Corrections are dated addenda.
  • No third-party analytics, ad or error-reporting services in the app.
  • Your patients' data is never used to train AI models.

We sign a BAA with every practice. A third-party penetration test is planned before go-live. Read our full promise on data, privacy and AI.

Founding practices

Become a founding practice.

We're starting with a small group of independent dermatology practices. Founding practices get locked pricing of $600 per provider per month and a direct line to the founder. Standard price after the founding group: $750 per provider per month. Pay a year ahead and two months are free.

10 spotsfor founding practices
Locked pricingfor your first 24 months
New practices welcomeno data to migrate

Four fields to apply. Everything else is optional.

Tell us more Optional

Please don't include any patient information. We'll only use your details to contact you about Fluence.

Rather talk first? Book 15 minutes

Opening your own practice? Read the free step-by-step guide. →

Apply for a founding spot →