OPTION 1: Hire A Practice Management Consultant.
Easier. Handles marketing. Attached cost (Negotiable. Example: 10% of revenues for one year)

OPTION 2: Do It Yourself.
-Less cost.
-More work. Can outsource some of it for a small fee.

 

STEPS IN CHRONOLOGIC ORDER:

START WITH THE FOLLOWING:

** ESTABLISH A SEPARATE BUSINESS ENTITY:
-Decide what you need PA (professional association) or LLC (Limited Liability Company) =       Discuss with tax accountant benefits of each.
-Recommend creating a company to shield your name, DBA = “Doing Business As”
-Decide who will establish the entity for you. Options:
      -Lawyer.
      -Accountant
      -Online.
-Obtain Tax ID (EIN) for the entity (done by above)
-Design a business logo.

** OBTAIN AN NPI FOR THE BUSINESS ENTITY. https://nppes.cms.hhs.gov/#/

** OBTAIN A MAILING ADDRESS = PO Box is highly recommended.

** OBTAIN A PRACTICE ADDRESS.
-This is important for credentialing with insurers even before the practice inaugurates.
-MUST be a street address. This can be:
      A: Actual office address:
          Sublease is cost effective early in practice. Share with PCP for
          referral benefits if possible. Ideally near a hospital for
           specialists.
      B: virtual address.
      C: One can use a PO Box address for a street address. Ask USPS
           and credentialer if this is possible. 

-See below for options of medical offices. 

AFTER THE ABOVE STEPS ARE COMPLETED:

** CREATE A WEBPAGE
Preferably one that offers a HIPAA email to communicate with patients. The EMR portal can do the same and is included in the price (should be)

** OBTAIN A BUSINESS BANK ACCOUNT. Specific for the practice.

** CREDENTIAL WITH INSURANCES:
–IPAs (independent physician associations): Involve yearly or quarterly fees. Inquire about which insurances they credential as not all IPAs cover the same insurances (you can determine based on patient population and fees, etc)
-Billing Companies: Some billing companies offer credentialing with insurances AND hospitals. This helps streamline the billing and collection process.
-Medicare / Medicaid / Health Exchange Insurances: Not included in almost all IPAs credentialing. For insurances not covered by IPAs, you or assistant can do this. Usually not difficult. Some will do for a fee.

** OBTAIN AN ELECTRONIC HEALTH RECORD (EHR) OR ELECTRONIC MEDICAL RECORD (EMR)
Things to consider:
-Cost with or without billing.
-Support and reputation.
-Included: Patient portal / Telemedicine etc.
-Contract review. Recommend legal advice. 
-Time to go live. Training needed prior to going live.

** OBTAIN A PRACTICE AND A BUSINESS LIABILITY INSURANCE.
–Practice Liability Insurance is to cover the practice (not the physician) from liability
–Business Liability Insurance is to cover the premises (office, cars use by staff, etc.) from liability. Be aware that this insurance auto-renews and if you do not cancel in writing they will charge you the premium!!

** CONTRACT WITH A BILLING COMPANY.
-Within EMR: Some EMRs offer billing services. Consider if this arrangement vs. a separate billing service is ideal for your practice. 
-Billing Software:
=Software to submit claims to billing company. Maybe included in the EMR, or separate with extra cost to integrate. 
-Billing Fees:
Rates differ usually from 3.5% to 6% of collection fees.
Inquire about what this rate includes: Clearing house fees, patient statements, other cost. 
-Clearing House:
= Entity that collects the payments from the payors and then delivers to the practice bank account.
-Fees may not be included in billers fees, so need to inquire about this from the biller.
-There are many. Payors usually determine which clearing house they use.
-Will need to credential with each one of them. Billers or practice may need to do the credentialing. 
ADVICE: Be aware of your practice accounting process even if you have to learn the basics. This is for many reasons, including: 
(1) If your practice manager leaves unexpectedly (e.g. resigns, acute or chronic illness, etc), you will be able to control your practice until a replacement is available. 
(2) Embezzlement is rampant in medical practices (do an online search on this topic). Being aware of basics of your practice financial management will enable you to supervise (periodic or sporadic) to detect inconsistencies and suspicious activities. 

** PRACTICE PHONE AND FAX.
–Phone systems: Phone apps (very convenient) and hardware (actual phone). Some come with texting capabilities at no extra cost. This is usually NOT HIPAA compliant texting. May or not include a fax number (extra cost). Fax needs to be HIPAA compliant.
–Faxes: Recommend a digital fax to avoid wasting paper and faxed items can be easily uploaded to medical records, etc.
*You may obtain a free HIPAA compliant fax number on www.doximity.com. *Other digital faxes are available at a cost.
*EMRs may provide a HIPAA compliant fax for referrals and medical record sharing. 
*Consider a separate fax line for office business. 

** HIRE PRACTICE STAFF.
-How many you need? Receptionist/ Medical assistant / Office manager. All in one?
-If possible, share office staff with other practices, especially if not full time. 
-Some physicians work without office staff especially early in their practice. 

** MARKETING. REFERRAL SOURCES.
–Print: Business cards, flyers, etc. 
–Advertise: Flyers, online (e.g. pay per click and per call), visits to referral source to introduce your practice, social medial, etc.

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MEDICAL OFFICE OPTIONS

LOCATION: 

For sub-specialists: Near a hospital and/or procedure centers e.g. dialysis centers for nephrologists / GI near endoscopy centers.

For PCP: Near areas frequented by people, e.g. shopping areas etc. 

OPTIONS: 

(1) Hospital medical office building: 

Advantages

-Ample parking and handicap accessible services.

-Fully furnished. 

-Office supplies/equipment, printer/fax (toner/paper) computers etc all included in rent. 

-House keeping included 

-Maintenance included in rent 

-Utilities and Wi Fi included in rent amount. 

-Steps away from hospital for easy rounding on inpatients during office hours.

-Close to ER for high risk patients- will still need to call 911.

-Can call hospital security for disruptive patients.

-Timeshare options (1) Can start with 1 day a week then increase – (2) Share with others their timeshare. (3) Sharing office staff is an option.

NOTE: Business insurance on Lessee (medical practice) 

Disadvantages

-Need to be on staff at the hospital – lose independence/ Competitors may interfere with this, etc. 

-Change of address later can disrupt practice temporarily (with insurers but also with patients). 

(2) Free standing office. 

-Maintenance by lessee?

-Rent amount goes up with the rental market.

-Need to furnish at lessee expense.

-Business insurance by lessee annually.

-Maintenance/ supplies/ house keeping etc. cost on lessor unless otherwise specified in the lease.

-Timeshare option not available – pay for all days of the week even if not using the office daily.

-Can’t sublease. 

-Can’t renovate. 

 

(3) Office ownership 

-Complete independence and stability. 

-High upfront cost but property appreciates with time. 

-Maintenance/ supplies/ house keeping etc. cost on owner.

-Extra costs: Owner association dues. Business insurance. Property taxes.

-Renovate / furnish as you wish 

-Can sublease to others to offset expenses above but need to find someone to sublease / increased operational costs / wear &tear etc.

Note: Advantages to some maybe disadvantages to others.

 
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Acknowledgement:
Many thanks to multiple colleagues in town and out of state for their valuable advice.

Note:
If there is an improvement to the above plan, please share by contacting us at info@SignatureKidneyCare.