fluence

ƒ(voice) = Note + Rx + CPT + Claim

EARLY ACCESSThe voice-first dermatology EMR

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.

Become a founding practice → See what you'd save Built by a board-certified dermatologist →

Savings

What your current setup costs you.

Move the sliders to match your practice. Fluence is one flat price per user, with billing included and no percentage of your collections.

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
Denial follow-up, about 4 hours a week of your staff
Estimated yearly savings

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 decides 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

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 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 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 go on 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 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.

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.

Founding practices

Become a founding practice.

We're onboarding a small group of independent dermatology practices first, with locked-in pricing and a direct line to the founder.

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

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