Rural Kentucky practice benefits from partnership with one trusted vendor

Faster collections, a rebuilt billing system, and 25 years of lab reliability—all earned through relationships, not just software and services.

Founded by University of Louisville School of Medicine graduate Dr. James Middleton, Family Medical Center of Hart County has served Munfordville, Kentucky, and the surrounding rural community since 1977.

Today, seven providers—one family practice physician, two pediatricians, and four APRNs—care for a population that is heavily government-funded (about 75% Medicaid and Medicare) and includes a significant Amish community.

As an independent, for-profit rural health clinic, the practice answers to no board and no outside mandates. That independence, says Practice Administrator Sky Marrese, is exactly what lets the clinic do things the way its patients need.

The clinic runs a full, CLIA-certified, in-house lab—about 100,000 unique tests per year—along with on-site digital X-ray and DEXA bone-density scanning. Patients are routed through standing-order labs and imaging before they ever see the physician, so results are often ready within about 90 minutes of check-in, all in a single visit.

Marrese is candid that none of this pays for itself. "The X-rays aren't profitable. The lab's not profitable," he said. Reimbursement, he said, will never cover the cost of the clinic's DEXA machine. The clinic runs these services at a knowing loss because, for many of its patients, there’s no other option.

According to Marrese, patients say, "If you can't take care of this, Doc, I'm not going to have it done."

Family Medical Center is a practice that holds itself and its vendor partners to a high standard. When Marrese talks about CompuGroup Medical, he's not just talking about software and services. He's talking about people.

In 2025, Family Medical Center of Hart County leased its first FTE (full-time equivalent) from ARIA RCM Services to cover for a staffing shortage and help with claims posting and invoice generation.

The practice's claims process runs through eMEDIX, CGM's own integrated clearinghouse. eMEDIX handles eligibility checks and ERA posting to keep claims clean and denials easy to manage.

Bringing in outside help required some consideration internally. The clinic’s own insurance department was nervous, worried they'd be replaced.

Over the first several months of the agreement, the practice worked with the ARIA team to decide which teams would handle which projects.

The arrangement was coordinated by Customer Success Manager Melanie McCracken of ARIA RCM Services, who worked directly with Marrese's own insurance manager.

Direct coordination is what turned a tentative pilot into an expanding partnership. When the clinic brought on a new provider and needed more billing capacity for overdue collections, Marrese didn't look for a new vendor—he scaled ARIA from one FTE to two.

For Marrese, the value isn't just capacity—it's the relationship underneath it. "I already have a relationship with [CGM]," he said. "CGM already knows something about my practice when I call."

Marrese joined Family Medical Center of Hart County in 2007, at the same time as the practice began using CGM eMDs. Following this 18-year partnership, the story Marrese tells isn't just about an important product enhancement. It’s about the relationship that led to it.

Early in his tenure, Marrese identified a billing problem: invoices were being tabulated as a single total rather than by individual line item, and this created specific headaches for his clinic’s process.

When Marrese raised this issue at a CGM User Conference event, he was pointed toward Patrick Hall, now VP of Marketing at CompuGroup Medical. When Marrese explained his issue, he was, in his own words, "just another guy" with no particular leverage as a customer.

The fix required rebuilding the billing module’s invoicing architecture—moving from an invoice-based model to a line-item-based one—an effort that took roughly eight months to implement.

“I can’t imagine what it cost them to do that,” Marrese says, “but they were willing to take that on because it’s what the software needed.”

CompuGroup Medical has established a pattern of hearing its clients and following up with them.

Marrese had asked, years earlier, for the clinical rules manager in CGM eMDs to support filtering by insurance payer. This feature request, he was told honestly, wasn’t simple to build. Then, about two years later, Product Owner John Waites brought it up unprompted in a call about upcoming development.

The insurance payer filter had made it into CGM eMDs after all.

Family Medical Center of Hart County has run CGM LABDAQ for 25 years—longer than any other CGM product in its stack—and Marrese's praise for it is almost entirely about how little he’s had to think about it.

"The great part is that CGM LABDAQ always works," he said. "There was never a problem with CGM LABDAQ that [simply restarting the server] didn't fix."

That reliability was tested once, when CGM notified the clinic it could no longer support the aging Oracle-based platform CGM LABDAQ once ran on.

For Family Medical Center, it was time to upgrade to the latest version of CGM LABDAQ with its modern SQL platform—a back-end database change Marrese admits made him "a little antsy."

CompuGroup Medical's Devang Thaker, manager of the client sales team, came on-site personally to help manage the migration.

"It's still stable, still good," Marrese says today.

The upgrade went smoothly enough that it became just one more entry in a 25-year track record—and one more relationship, with Thaker, that Marrese says he's genuinely glad to have.

Three different product lines. Four valued relationships—Melanie McCracken, Patrick Hall, John Waites, Devang Thaker—all built across nearly two and a half decades.

For a seven-provider clinic in rural Kentucky that will never be CompuGroup Medical's biggest account, the pattern is the point: specific people took the time to understand how this particular practice works, and that's what turned a vendor relationship into something Marrese is willing to keep expanding.

"I know that there are great people behind it," Marrese says. "And I value those relationships."

That's not a low bar. It's the same standard his own clinic holds itself to with its patients—and it's why Family Medical Center of Hart County keeps choosing to grow with CompuGroup Medical rather than look anywhere else.

Ready to see what a partnership like this could look like for your own practice?

Learn more about our EHR solutions, lab management software, and billing services, or contact us to talk with our team about what your clinic actually needs—not just what's in the catalog.