Practice Checklist

Practice Startup Checklist

Practice Start-up Checklist

We understand that you might be required to accomplish some of these items in a different order but this outline should provide you with a rough idea of what’s needed to get started. Complete red items first then move to phase II & III.

Color Code from the day you decide to start a practice:
Phase I- Approximately 220 Days Out
Phase II- Approximately 120 Days Out
Phase III- Approximately 90 Days Out

Facility
• Create business plan for first two years
• Find location-This should also involve an analysis of payer mix. See our article on performing a location analysis

Location Considerations:
Demographics, Anticipated Payer Mix, Competition, Parking, Growth, Regional Development (New Schools are often a good indicator of growth), Cost, Lease Term, Efficient Layout for Productivity, Nurses Station, Waiting Area, Handicap Accessible, Phone/Internet Options (some owners have telecom contracts that you have to participate in) and much more. See our article on performing a Location Analysis

**This is around the time that you should start the credentialing process. You should start as soon as you have a solid idea of where your practice will be located. Credentialing time frames vary by state and insurer but you should give yourself at least 120 days**
• Decide on ancillaries, if any. This is needed to ensure your facility can accommodate the services you plan to provide
• Sign lease or mortgage (this can wait until 60-90 days if it is turnkey). Try to negotiate 1st payment 90 days after start date to improve cash-flow
• Design layout of new office (If Needed)
• Order phone/fax/high-speed Internet access lines
• Order medical equipment (Keep costs low at first, look at used equipment and remember government tax credits)
• Order office equipment (Leasing Computer equipment has become a great alternative for many practices)
• Order office furniture

Supplies

• Order medical supplies
• Order office supplies
• Order supplies for ancillary services (lab supplies, etc.)
• Order lab coats, staff uniforms, name tags
• Order medical record filing system and charts (unless starting with an EMR which is recommended)
• Order signage

This should be done once when you are narrowing down your practice location. This doesn’t take much time to complete but is a necessary first step before you can get set up with Medicare and Commercial Insurers.
This should be done once when you are narrowing down your practice location. This doesn’t take much time to complete but is a necessary first step before you can get set up with Medicare and Commercial Insurers.

• Find an accountant or consult with someone regarding your initial practice organization
• Incorporate practice
• Obtain federal tax ID
• Arrange for working capital loan, if needed
• Open business checking account
• Open merchant services account-Ensure they have the ability to interface with your website for online payments. You can also check with the practice management program to see if they have a solution.
• Arrange liability insurance, disability insurance, worker’s comp insurance, retirement plans, and health insurance
• Set up practice fee schedule
• Open a lock box, or decide upon payment address. If signing short-term lease you should consider having a separate payment address. Prevents potential for payment delays when moving
• Request fee schedules and upload into your billing system. Obtain Medicare, Medicaid and Worker’s Compensation fee schedules

Billing

• Become a participating provider with commercial and managed care payers
• Obtain provider numbers from Medicare and Medicaid
• Obtain DEA number and ensure it’s updated with the state where you’re practicing
• Obtain state and federal narcotic license, if needed
• Obtain state medical license- you must have this before credentialing can begin

• Contact state compensation insurance commission for worker’s comp fee schedule and forms
• Contract with third-party clearinghouse, if needed. This is not needed if you’re outsourcing your billing to a third party
• Order CPT, HCPCS, ICD-10 and Correct Coding Initiative books if doing in-house billing
• Create practice superbill/charge ticket
• Develop Accounts Receivable systems and policies
• Contract with a collections agency

Operations

• Obtain licensure for ancillary services (e.g., CLIA for laboratory) as needed
• Arrange for transcription, if needed
• Decide which scheduling method to use and program the practice management system
• Arrange for call coverage, if needed
• Set up answering/paging service, if needed
• Establish charge capture system (outpatient and inpatient)
• Create/get forms including:
• HIPAA Notice of Privacy Practices
• HIPAA Business Associate Agreement
• Consent to Treat (as required by state law)
• Assignment of benefits
• Registration form(s)
• Medical history form(s)
• Advance beneficiary notice (for Medicare)
• Financial policy (for patients)’

Staff

• Arrange for payroll services, if needed
• Determine office staff needs and write job descriptions
• Write employee policy manual and policy procedure handbook
• Decide upon and obtain employee benefits (health, life, leave, etc.)
• Consult Medical Group Management Association benchmarks for staff per FTE physician
• Hire staff (consider a manager; staff who will handle billing, scheduling, check-in, transcription; and staff who will provide clinical and ancillary support)
• Implement OSHA & compliance requirements

Business development

• Develop branding and marketing strategy
• Design custom logo and start incorporating on all communication about the practice
• Build website and optimize it for your local traffic & specialty
• Integrate your new website with your EHR’s patient portal
• Build social media properties and integrate them into your new site
• Create and print business cards and stationery
• Arrange for hospital privileges and meet with hospital administration to discuss your new practice
• Plan for an open house
• Send press release to local media about new practice
• Introduce yourself to referring physician

Technology

• Select practice management system (billing, scheduling, patient registration, etc.)
• Select EHR. We have an exclusive offer from Athena Health. Contact us to learn more
• Order servers, terminals, printers as needed
• Remember that you can utilize a digital fax and web based programs
• Set up internet service
• Create secure e-mail accounts with your domain

Other

• Write partnership and/or employment agreement for physicians, including policies for compensation, overhead allocation, call, part-time work, retirement, buy-in requirements, and leave (maternity, military, etc.)-