With regards to nursing homes there’s a second level. I’m going to borrow from my own past writing here :

Due to the way that insurance pays these days and that they can take up to 18 months to review and deny a claim at which point you have to pay them back, it’s becoming harder and rarer for single practitioners or small groups to have the ability to have a practice (unless cash based, which is difficult and excludes a lot of people from care which I have FEELINGS about). Corporations have the administrative ability to have a dedicated coder, dedicated team for denial challenges etc. However corporations are predictably exploitative.

I really don’t see any way to run anything medial based without a dedicated admin team ensuring cashflow. Which sucks. It also costs a ton of money up front.