Member Forum

Subject: logistics for starting a new practice

1.  logistics for starting a new practice

Posted 01-03-2017 20:42

Hello all,

Any advice for logistics in starting a new primary care practice (in Colorado)? I was referred to your group a few years ago by another NP.

How long does credentialing take (most of my patients are Medicaid)? I am assuming I need to start credentialing once I have a physical space-is this correct? Are virtual offices a good idea-and will I have issues with credentialing if I use a virtual office? Do you bill yourself (or hire a biller)? 

I also wanted to thank the group for your inclusivity, as we all want to provide excellent care to our patients.

Marie Amina Aryan, NP-C (aka "Guest" for this week)

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IMP Guest
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2.  RE: logistics for starting a new practice

Posted 01-04-2017 03:09

Hello:
I started a new practice in Florida in 2015. I am a family physician. I started with registering and forming the corporation. An accountant can help you with that. In your case might be different since you are a NP. Make sure you have the start up money in your bank. I had an approval letter by Bank of America in NY. They never released the money. It has been a really hard year. Blue Cross /Blue shield of Florida took more than 1 year in approving me as " in network" could not collect in about 40% of my patients. Did I say that it has been a very hard year?? The best for 2017 to everyone here.






3.  RE: logistics for starting a new practice

Posted 01-04-2017 11:01

Thank you for your insight Edgar.  I hope this upcomming year is better for you.

Marie

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IMP Guest



Best Answer
4.  RE: logistics for starting a new practice

Posted 01-04-2017 06:22

Marie, 

Thats what I do, family medicine with Medicaid in Colorado. I have been open in Colorado 5 years now (Ardas Family Medicine

), growing from zero to now 50 pts a day, 4 full time providers. Co Mcd credentialing takes only a few weeks, and yes you need an address first. I wrote somewhat of a step by step guide to opening your own practice. Write me a private message on here if you want to discuss.

P.J. 

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PJ Parmar



5.  RE: logistics for starting a new practice

Posted 01-04-2017 10:02
I would recommend contacting Rose Medical Group. They are based out of Rose Hospital in Denver but I believe they work with providers throughout at least the metro area regardless of hospital affiliation (or lack of any hospital affiliation). They handle contracting for $500 per year with all private payers. Medicare and medicaid need to be done on your own but I bet they would give you some support there.

http://rosemedicalgroup.org




6.  RE: logistics for starting a new practice

Posted 01-05-2017 07:03

Billing- we do ourselves in house.  It is much more affordable than hiring someone and I find not that complicated. 

I pay one person 10 hours a week to do our books and our billing. I think as I make my billing systems more efficient I can then also use her better to do reporting and tracking.   She didn't have billing experience.  I learned just by doing and taught her what I know. We still learn each month that goes by as the rules with insurances change.  While I don't enjoy this work I find it useful knowing the details of the money. 

I find the paperwork to maintain credentialing the biggest challenge.  It takes a lot of work and every 3 months there are requirements for updated paperwork.  I am now also training someone to do this work and some of the back office work as well as chasing some of the more complicated insurance problems for another 5 hours a week.  

We have two providers in our office.

For me credentialing was easy as I was already set up as an employed doc. When I left that job I just changed my address and affiliations. When I establish with a new insurer I find it takes about 2 months from start to finish.  This partially depends on how much time I have to do all of the paperwork. 

Good luck. Keep the questions coming.

Melissa

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Melissa Weakland MD
Ballard Neighborhood Doctors
Seattle WA
IMP since 2007



7.  RE: logistics for starting a new practice

Posted 01-18-2017 12:37
Started a practice in WA state and I have a power point on starting a practice on a shoestring.  Happy to email or talk with you about specifics.

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Deonne Brown-Benedict DNP, FNP Charis Family Clinic Edmonds, WA www.charisclinic.com
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8.  RE: logistics for starting a new practice

Posted 01-19-2017 18:01
I started in WA on a shoestring also.  Used this group years ago to get great advise and guidance.  It took me about 40 hours in one week to sit down and walk thru everything with finding location, registeringthe business, and all the other stuff I had to do to apply to get contracts and stuff, but really it took about 3 months to finish it.

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Amy Adkins-Dwivedi
Stepping Stone Pediatrics
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9.  RE: logistics for starting a new practice

Posted 01-20-2017 09:40
Thanks for the imput!

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Marie Amina Aryan
Lakewood CO
303-981-1902
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10.  RE: logistics for starting a new practice

This message was posted by a user wishing to remain anonymous
Posted 06-16-2017 15:52
This message was posted by a user wishing to remain anonymous

Hi All,

I have a question about the sequence of things to do:

I'm credentialed to an existing group, and I'll leave to create my own practice in 1.5 months. When I give them notice, I'll want to begin talking to insurance companies to change my address & tax ID.

However, I haven't formed a corporation yet, but I plan to start now.

The issue is that I am still in the process of leasing a place, so I don't know my business address.

I want to have my corporation's tax ID ready sooner so that I can start insurance re-credentialing sooner.

There is a way to just use my individual name as a sole proprietorship, but I think using a Professional Corporation with S-Corp election in California has its benefit.

My key question to you all is:

Will it work if I rent a UPS business mailbox, use that address to apply for a CA Professional Corporation? Then, later on when I get the lease, I reassign the business address to my leased office.

Will it work?


11.  RE: logistics for starting a new practice

Posted 06-21-2017 10:27
An accommodation address should work.  How would they know the difference?

RE S-Corp--what advantages do you see over partnership/sole prop with a SIMPLE IRA or SEP IRA?  Corporations offer no tax advantage, and no business advantage, and it complicates your life.  Lawyers like them, since they generate more fees for them.....

Employer liability?  A corp is no longer a shield:

"Expanded liability for wage and hour violations to individual owners, directors, officers, and managing agents via new Labor Code section 588.1.

In California, wage and hour rights are closely regulated by statute under the California Labor Code, which prescribes, among other things, such employment aspects as the payment of wages, minimum wage and overtime requirements, and meal and rest period requirements. Additionally, the now defunct Industrial Welfare Commission was empowered to formulate regulations, known as Wage Orders, governing employment in various industries and occupations. The California Division of Labor Standards Enforcement (DLSE), headed by the Labor Commissioner, is empowered to enforce California's labor laws. In addition, the Labor Code affords employees private rights of action against employers for wage and hour violations....
(There once was a 'corporate shield'..)

However, the "A Fair Day's Pay Act" amends the Labor Code and adds section 588.1, which expressly defines "employer or other person acting on behalf of an employer" to include a "natural person who is an owner, director, officer, or managing agent of the employer." As a result, an employee can now bring wage and hour claims against the corporate owners, directors, officers, or managing agents (e.g., department supervisors, payroll managers, human resources managers, other employees with the authority to transact on behalf of the business) who violate or cause to be violated various wage and hour laws in the Labor Code and name them as individual defendants in a lawsuit. Additionally, the new law amends other portions of the Labor Code, empowering the Labor Commissioner to investigate, hold hearings, and recover civil penalties and citations from individuals liable under new section 588.1. As a result, individual corporate defendants are no longer immunized from personal liability for wage and hour violations."  http://www.mondaq.com/unitedstates/x/464220/employee+rights+labour+relations/California+Expands+Personal+Liability+For+Wage+And+Hour+Violations+And+Enhances+Labor+Commissioner+Enforcement+Measures+Under+The+New+A+Fair+Days+Pay+Act

IMO, the general liability shield doesn't outweigh the expense and bother till you get much bigger.  (Never was a shield for malpractice liability.)
In CA, the corporate structure just doesn't offer much protection- which is a good thing, in my  opinion.  Why should businesses be allowed to abuse people with impunity?



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Peter Liepmann MD FAAFP MBA
My mission is to fix US health care www.PCMHpcc.com
Bakersfield CA
5183026006
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12.  RE: logistics for starting a new practice

Posted 20 days ago
Hi, I'm waiting for them to activate my email/ password combo but wanted to pass along our blog post with the steps for starting a practice:

Steps To Start a Medical Practice
Solo Building Blogs remove preview
Steps To Start a Medical Practice
Anywhere from three months to a year. The first step is deciding to go solo. We know of some colleagues who have been "deciding" to go solo the last two years. Their job may not be intolerable but not great, so there's no huge impetus to push you to go solo.
View this on Solo Building Blogs >


Definitely do your own billing, collect all patient responsibilities upfront at the time of service after verification with your practice management system!

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solobuildingblogs
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