How to Start Your Own Medical Practice

Everything downstream keys off your legal structure, so this comes first. Your attorney and CPA choose the entity. We make the paperwork match it: EIN with the IRS, business bank account requirements, and the NPI structure payers will check on every claim. If you incorporate, that means a Type 1 NPI for you as the clinician and a Type 2 NPI for the entity, linked correctly, with you listed as the Authorized Official in NPPES. We also create your CMS Identity and Access account here, because that single login gates both NPPES and PECOS later.

One discipline we enforce from day one: a single practice address, phone, and fax, written the same way on every form. More enrollments stall on address mismatches than on any other single cause.

If you are not yet licensed in your target state, this is the longest government timeline in the project, so it starts immediately. Every board is different: some states require FCVS credential verification, Texas adds a jurisprudence exam and issues licenses twice a month, California tells applicants to file six months ahead. We prepare the application, assemble the verifications, and chase the board on a schedule instead of hoping.

In parallel we file your DEA registration, which runs on its own Department of Justice portal and is online only, plus the state controlled substance registration where your state requires one. We also get your malpractice policy bound now, because nearly every payer application in phase 4 will demand the certificate of insurance and your coverage limits.

The moment your license and NPIs exist, we file the PECOS 855I for your Medicare enrollment, including the reassignment of benefits to your entity, and set up electronic funds transfer so Medicare pays your bank account directly. Since late 2023 the reassignment lives inside the 855I itself, one more form change that trips up people who last enrolled years ago. Individual physicians pay no Medicare enrollment fee; that fee applies to institutional providers, whatever a forum thread told you.

State Medicaid runs on its own portal with its own rules, and managed Medicaid plans often credential separately on top of the state enrollment. We file it all and log every confirmation number, because Medicaid is the payer most likely to lose an application without telling anyone.

This is where launches live or die. We build your payer target list from the actual employer and insurance mix in your area, not a generic top ten, then construct your CAQH profile once with every document payers will ask for. From there we file with each payer on your list: Aetna, the Blues, Cigna, UnitedHealthcare, Humana, and the regional plans that matter in your market.

Then the part nobody warns you about: follow-up. Payers measure response time in weeks, and applications genuinely go missing. Every submission gets logged with a confirmation number and a next-touch date, and we call on that date, every time. When contracts come back we review the fee schedule against Medicare rates before you sign, because the first offer is rarely the best one. This is the same credentialing and contracting operation we run for established practices, pointed at your launch.

Which EHR should you buy? The honest answer: it depends on your specialty, your telehealth plans, and your budget, and the vendor sales rep is the wrong person to ask. We are vendor neutral. We shortlist two or three systems that fit how you will actually practice, sit in the demos with you, and translate the sales pitch into what it means for your billing. If you want zero software cost, free EMR software is available through our billing service, and we will tell you plainly whether it fits your specialty or whether you should pay for something better.

Then we set it up completely, because an empty EHR is just an expensive login. Appointment types and scheduling rules, charge capture and superbill mapping for your common codes, your fee schedule loaded, e-prescribing including the identity proofing that controlled substances require, patient portal, telehealth module if you need one, and user accounts with the right permissions. You and your staff get trained on it before opening day, not during it.

Underneath the EHR runs the money plumbing. Enrollment gets you in network, but it does not make claims move. That takes clearinghouse connections: EDI enrollment so claims go out electronically to each payer, EFT so each payer deposits to your account instead of mailing checks, and ERA so remittances come back electronically and post automatically instead of someone keying paper EOBs at ten every night. Each payer has its own EDI form, and some want them signed after your contract is live, which is why this phase is sequenced where it is. Before your first real patient, we push test claims through the whole stack so opening day is not the first time your billing pipeline runs end to end.

While the paperwork grinds, we build the machine that fills your schedule. A website in your name on a domain you own, written for the patients you actually want and structured so search engines understand exactly what you do and where. Google Business Profile verification starts early because Google can take weeks to verify a new practice address, and an unverified profile is invisible in map results.

By opening day you have a live site, a verified profile, consistent listings, and a review pipeline ready for your first patients. This is the discipline we used to rank our own site nationally in one of the most competitive corners of healthcare, applied to your zip code.