On a weekly basis, I am finding email, phone calls and letters from Nurse Practitioners who are looking for information on starting their own business.
This article is a synopsis of an article I wrote that was orginally published in Advanced for Nurse Practitioners. It has since been updated and can be found at NPBO.
1. Develop a support system.
None of us operates in a vacuum. It is essential that you develop a team of professionals to assist you. That team may starting with an business attorney and CPA in order to start you out on the right foot both legally and financially.
You will also want to network and mastermind with other NP Business Owners who have already traveled this road. It will likely save you time, money and frustration.
2. File the necessary paperwork.
The paperwork alone will keep you busy! You will need to file for the necessary business licenses and permits. You need to get an NPI number, which should correlate with your new Tax ID number. As soon as humanly possible, if not before, begin the credentialing process with Medicare. That one will take the longests. File the others as soon as you can.
3. Find an affordable location.
Where you want to locate your practice is an important decision. Consider how much space you need now and for futuer growth. In your mind, walk through your space to determine what you think you will need. Make sure it feels good as well as make good financial since. Considerations including leasing a medical office, buying and remodeling a space as well as building from the ground up.
4. Research budgetary projections.
As soon as possible, start gathering information about reimbursement rates from payers. With this information, you’ll be able to make some projections about your potential gross and net income. Don’t forget to factor in the lower reimbursements that many still pay NPs.
5. Scout around for insurance.
Shop early for your liability insurance. Almost all payers want to see proof of your malpractice coverage prior to credentialing you. This includes many of the plans you may already be credentialed with.
6. Hunt for affordable and functional equipment.
I don’t buy the idea that you have to spend a huge amount of money to open your business. Nor does everything need to be brand new. I did a lot of shopping at surplus retailers as well as eBay. Likely you will purchase both new and used equipment. Consider keeping your shopping list to those items that you will really needed initially, as well as those items that you can show a good return on investment (ROI).
7. Outline your staff strategy.
What roles will have to be filled as your practice grows. Who can you utilize in more than one positing as you get going? Remember, when thinking about staff, you will have lots of additonal fees and taxes associated with being an employer.
8. Learn all you can about billing.
If there is one thing I wish I had known more about before beginning this practice, it would be billing. Reimbursement is the cause of most of my business headaches, and has nearly closed more than one practice. I cannot emphasie this enough. Learn it, and then monitor those who are doing it for you.
9. Let people know about you.
Marketing! I once read that we only think we are in busines to provide whatever widge we are providng, when it truth, our true job is to market. We have no business without our clients and patients. The way they find us is marketing – yellow pages, word of mouth, referrals, insurance companies, websites, and newspaper ads to name just a few.
10. Look Ahead.
Take the time to identify your goals and keep them updated. Decide how you want to grow and when it is time for you to move on. Make sure, as much as possible that you build a business that fits you and your lifestyle.
I believe that more and more resourceful and creative nurse practitioners will make the jump into private practice. It only takes a few core steps to mark out the path to myriad opportunities.
I’m really glad that you have made your sites for those of us who will some day become independent practitioners. I look forward to the day that Florida becomes an independent practice state. I’ll be glad to see us get the ability to prescribe narcotics for that matter! Only two states left!
I have been an Nurse Practioner for over fifteen years and did start my own business in 2005. I found it very difficult to sustain beyond six months which was all I had prepared for. I made very little money as a Clinician and most of my money as a Educator. I contracted with a local community organization to provide HIV/AIDS Health education. Those six months were difficult but I now know where my real passion lies. It was like obtaining a business degree and although I made alot of mistakes I learned from the experience. I am currently working for NYSDOH as a Public Health Consultant. but would give almost anything to have the chance ,one more time to have my own practice. I decided I will have that chance and will start out slow this time setting up my Women’s Health traditional and holistic practice in my home. If anyone has any tips on getting a collaborating physcian please share with me.
The Sister’s Upper Room
Jamila Ali RN-C WHNP MSN
Hi Jamila,
You are so right on when you say starting a practice is like getting a business degree. I figure I’ve earned am MBA & a PhD! 🙂
Getting a collaborator will vary from state to state. But in general, the place to start is in your own community. In NY you have to have someone sign on as a collaborator…so what about the person who currently signs for you? If not what about their colleagues? Others in your specialty? Seek out physicians who are already working with an NP in private practice, or are at least familiar with working with NPs.
A few other resources:
Carolyn Zaumeyer’s book “How to Start an Independent Practice”discusses this in Chapter 5.
The December issue of Advance for Nurse Practitioners (being mailed now) has an article on “ Finding a Collaborator”.
NPBO has articles as well as a sample agreement used and shared by one of the members.
Keep us posted on how you are doing.
Barbara
I am currently attending an post masters FNP program and would like to start my own practice. I have worked for myself before contracting my services to ICU’s doing acute care dialysis and found it very rewarding. What I would love to find would be a mentor, I’m sure I would argee to slave labor for the opportuinity to learn how to start my own practice. Dermatology would be my preference and I would move where nessisary to obtain the experience. I wouldn’t expect to be employed by them, rather something like an intern in return for the skills to set up my own practice.
Just starting out – where do you find financing for a start up business in an economy we’re in right now? I’m afraid to really “dream” until I know what is available to me.
I am in the early stages of independent practice – just got the motivation to take the big leap, but hesitant due to the “little things”. I want to provide my services to ALF’s, as an independent contractor. Who would I seek as a mentor to help me decide how to reimburse the ALF – a percentage of collections, or per patient, etc. I would take all my equipment/supplies, would have my own insurance (also need help in figuring out if I need additional malpractice coverage in addition to the policy I have with my current employer). I also would have someone do my billing. I am in the process of writing a proposal for the ALF, but not sure how to reimburse them.
Hi Debora,
I see patients in ALF myself, I really enjoy it. It’s a good business model with low overhead.
You do not need to “contract” with them. You bill Medicare directly for your services, much like an office visit, only use the E&M codes that are specific for ALF’s. No sure why you need to “reimburse” the facility.
You definitely need malpractice, your own business license, structure, EIN and NPI.
There are some articles on AFL here and on http://www.NursePractitionerBusinessOwner.com.
Feel free to contact me through this blog.
Barbara
I’m about to join an NP practice (as an independent contractor) that’s already established. We provide care to home bound pts. We are planning on expanding services to include office-based care, as well. Two questions: 1 – there’s a clause in our agreement that’s states I would not be able to have a professional relationship with pts for a year if I were to leave the practice. Should I seek to exclude new pts that I bring in to the practice? 2 – how would we make the transition to my becoming a full partner in the practice? Would I need to buy in with a cash amount equal to the met worth of the business? How does that usually work? Thank you!
I would like to start my own practice in Texas, and I would like to know the steps that I need to follow up.
Thanks
Aida
Hello Aida,
In addition to the above, I go into these 7 steps (in depth) in our course, http://npbostarterkit.com/. Check out the video which will tell you more about the 7 steps and let me know if you have additional questions.
have been offered a site fully equipped and has a collaborator. I am fully lic and certified. I thought the new grads as of 2015 require the DNP. I am only MS level. they want me to get them started as an APN facility and OH big one no rent for one year to get it up and running. I want to but nervous. I have experience opening other people facilities not my own.
Hi Kris,
We are not yet at a place where DNPs are the entry level for Nurse Practitioners, but it will come.
Congrats on this opportunity you have ! It’s good to be nervous, even though you have experience. Keep us posted on how you do and let us know if you have questions.
Barbara
I am interested in having my own private practice in texas. I don’t know how to start. Are there many practice option? example owning a clinic, home health or nursing homes? I am so clueless.
Please help.
Thanks.
Hello Nta,
There are many practice and business options for NPs. It really starts with what you want to do, identifying your own clinical strengths (if you are interested in a clinical business) and then researching the area to determine feasibility.
There are several options for you to receive more assistance and I’ve listed several of them on http://npbusiness.org/work-barbara/.
Let me know if you have further questions.
~ Barbara
Thanks for your prompt responses. I registered today with the nurse practitioners business owner. I surely will go the site and check it out.
How long does the whole process take? Is the inital financial requirements too heavy?
Welcome to NPBO™!
The answers to these questions depend on what exactly it is you want to do. Be sure and join us for the Members Only Q&A call and we can discuss your situation specifically. Also, make sure you get involved in the private FB group for members only. I look forward to learning more about your journey to owning your own practice!
Hi Barbara
Any insight of the dangers of joining a start up company as the NP? I guess l can explain in detailed… as l want thru grad school my employer at the time owned a home health company n l was the DON. Now that l a NP he wants me to come up with a way to start a wellness venture ran by NP. l am clueless as l just graduated… speechless!! l live in dallas TX
Hi Ester, while this sounds like a good opportunity, I would look at it very carefully.
I’m not clear from you question if you would be the business owner, if this would be a partnership or if you would be the employee/intrapraneur, but here are some thoughts.
As you just, you just now graduated. I would advise you to focus on becoming an expert clinician. As a rule, I generally recommend that new grads take the time to hone their clinical skills….and start to learn about business.
Every NP needs to have basic business skills including how reimbursement works, negotiations, contracts and more.
Let me know if you have further questions about this.
~ Barbara
Hi Barbara
Thanks for the prompt response. I’m a contracted employee to a boss that is not a medical professional (can’t hire medical professionals). Per my understanding l am contracted in his wellness company that has no structure at the moment. My fear is that he believes l can come up with a business plan and structure of how he can generate revenue from having me as an employee:). My brain is completely stuck as I’m a novice FNP n not sure how l can go about all this….
About the basics business skills acquisitions what settings is better? clinics or hospital? any insight?
Ester,
While this sounds like a good opportunity, I would think about it carefully. While working in wellness can be wonderful and fulfilling, would you be better served to spend some time as a “regular” employee learning how to manage patients with a variety of needs first? And then later, with the background of what happens when one is not well…venture into wellness. You’ll have a greater depth of experience and expertise to guide your patients at that point. (IMHO).
What your current employer is asking you to do (from what I understand) is to really create the practice (and teach him what to do) in terms of clinical operations, business operations, billing, fee schedules etc. It’s a lot for a “novice NP” to create when you are just starting your practice.
If you really want to go forward with this, I would recommend getting a course that walks you through all this, work with a mentor and take your time.
~ Barbara
Hi Barbara
Thanks for your input. l have recommended your 2.0 course to my boss. hopefully we both can learn together as we explore this lovely profession. Thank again!
You are welcome Esther. Let me know if you have further questions.
~ Barbara
I have been in practice for the last past 3 years working at a Community Health Center. What I want to do is open up a women’s health clinic in NY to serve the underprivileged and underserved population. I would be partnering with another NP who is a close friend of mine. I do not know where to start this process or how to build a timeline.
One of the first places to start, especially since there are two of you is to explore your goals and values individually….and then together. Make sure that you both on the same path. Partnerships, especially when there is any ambiguity, can deteriorate rapidly.
You also want to explore the finances of doing this project and make sure that’s it’s going to be financially feasible. What will your cost be, what will your reimbursements be? Obviously, a lot to explore. You didn’t say, but if you are considering a non-profit model, keep in mind you still need to make money to cover cost. And there are additional requirements to be a non-profit.
If you really want to dive deeply into this, I’d recommend our course. You can find more details here.
hello Barbara
I am considering starting own Np practice as well and am currently doing the research in seeing if I can make the leap and if it will be cost beneficial.
I am having trouble getting information on what reimbursement pay would be for common visits that my target population would be.
Do you have links or helpful info that could help with this gathering of data.
I don’t want to put all investment into an office lease, state licensure, etc when the reimbursements are not going to pay out what I would need.
Trying to do a cost analyses but do not have a good resource for this.
Tried calling the main provider BCBS, but cannot get through to anyone to call me back. any help would be very appreciative.
Thank you
sonia
Hi Sonia,
You are absolutely correct, you need to gather all your information before you invest in starting a business.
Medicare and Medicaid (and workers comp) reimbursement rates are all public information, so you’ll be able to get that information from the appropriate websites.
Unfortunately, commercial payers don’t readily share their “proprietary” information such as reimbursement rates. However, most often you can call “provider relations” and give them 5-10 CPT codes and ask about reimbursement.
If you are unable to get a hold of someone, try provider enrollment at BCBS instead of a provider rep.
Hope this helps. Good luck and let me know how it goes.
~ Barbara
Hi Barbara,
How would I go about researching an NP led business where the only focus is routine school/sports physicals. No brick and mortar location but travel to different schools to perform them low fee cash only basis.
1. Is there a need for this in your community?
2. How many schools are there and how many students?
3. How would you receive payment for those services?
4. What will be your fee?
5. What will the overhead be?
6. Will you be able to see enough students, at your fee schedule to cover all cost and make enough money?
Hi Barbara
I am in South Africa. I want to start an NP Practice in Mental Health. I’m just not quite sure how to start and how to get funding.
I am thinking about opening a dermatology center which provides Botox, laser hair removal, microdermabrasion therapy, and chemical peels. As a NP will I be available to do so, or do I need to a MD? Please advise me.
Much of this depends upon your state rules and regulations. It is critical you understand your scope of practice and any rules restricting practicing for your state before you move forward.
Sipokazi, I don’t know the rules that may restrict or may not restrict practice and practice ownership in SA. Become familiar with the rules and regulations. When starting up, you must start with research – including all the financial aspects and then determine what you will need. Part of that research will include finding sources of funding. Good luck and let me know if you have further questions! ~ Barbara
JMM
I have read about private practice and the need to research. I have heard interest in private PMHNP practice. This give me an idea of how private practice is a challenge. thank you all for contributing to this discussion. I will be visiting the site often.
Thanks for commenting Julie.
I would like to start my own practice in Florida, and I would like to know the steps that I need to follow up.
Thanks
Yusimi
Hello Yusimi,
Thanks you for your question. It’s impossible to answer the question in a short blog reply.
If you download our mindmap, it will give you a lot of information of the various steps to starting a practice. As you search thru the blog, you’ll find a lot of information on starting a practice. If you’d like help going through all the different steps, in detail, then I refer you to our course. https://www.clinicianbusinessinstitute.com/p/piab
Please let me know if you have additional questions.
Hello Barabara
I live in Michigan, FNP working in a Level all ER, I want to open my own practice, but would like a partner, is that a good idea? Or should I start my own business and hire a part time NP? How do I fine another NP loving for a partnership?
Paula
Hi Paula,
Partnerships can be done, but realize that in a partnership you can both be held liable for the others business decisions/actions – both good and bad. If you go the partner route, it’s best to get legal advice on how to best protect yourself and your partner and to limit the liability on each side. Partnerships require clear communication, similar goals and work ethic IMHO.
Another option would be to create an LLC (if allowed in your state), and bring on another “member”. You can structure it to also limit their involvement and your liability.
Don’t forget since these are also tax structures, to talk with a good CPA who can advise you as well.
Thanks for stopping by!
HI
I’m from SA I am still in the very early ages of my practise, this is what I done/planning
got my practice number,
have a mentor,
busy with business for marketing and a website as well.
buying my wound packs and basic wound dressings to start of , assessing what the Dr prefers and the type of wounds I came across,
joined WHASA wound org , for updated training and SANP a support group for nurses ,
will work after hours and weekends until business picks up and than FULL FORCE, its scary but feels liberating at the same time.
Sounds great Charly! Congrats.
Can you tell us more about your scope of practice in SA?
Hi Barbara
I am an FNP, most of my experience has been with psych and would like to start my own practice: outpatient mental health clinic in Florida. I would to know if this is possible in this state? Also where would be a good starting point?
thanks,
Rosa S
Hi Rosa,
Yes! Starting a practice in Florida is doable as many of your colleagues have shown. You do have a few hoops to jump through just like any non-FPA state. Where to start? Start with planning. Define what it is you want to do, who would be your ideal clients, how would they pay for your services, and if you take insurance, which payers would you consider. If you have not already, pick up a copy of our practice mind map (it’s free, see the blog sidebar) which will help you map out different components of a practice. If and when you are ready for more, check out ClinicianBusinessInstitute.com Good Luck!
Hello! I am nurse practioner in CT. I work in an office right now for a big company. I have been given the opportunity to do med management for mental health clinician who can not prescribe. I’m wondering if I need a new npi number and a tax id.? Would I need to take insurance and if I do, do can I credential with payors as a separate entity from what I am now? I would one day hope I can grow this into my own practice but for now would be doing both jobs.
Hello Aericka. The answers are yes!
1. First, I assume this is within scope of practice for you. I bring that up, because it’s becoming a hot topic.
2. I’ll assume you plan on doing your own billing for this. You’ll need to go ahead and create that business, complete with all the appropriate business numbers (TaxID/EIN and NPI-2).
3. You’ll want to get credentialed under your new business. That will keep work you do for your employer separate from what you will do in your own business.
Thanks for the question and good luck!
I am a NP, have been one for 10 years. I worked in Montana in a clinic and then moved to Texas about 8 months ago. Currently in the process of going back to Montana to open a clinic in the same area I left. Do you have any good advice? We have a building, it is a home that insurance has already cleared to use and we will remodel it for the needs. I am working on an EMR and one that will have a billing with it, currently looking at 4 different ones. we are trying to come up with check list of things we need to do. Working on picking a name for business so we can get it registered and then hiring someone to start credentialing, I am working in texas until this is closer to happening and we are hoping 6 months, that is our goal/window. I am open to any help that you can provide. I tried to click on several of the links in comments above and could not get any of them to work. Thanks. for any ideas/lists you may have.
Hi Laura,
There is a lot in this blog on getting started. You’ll notice on the sidebar there is an image that will allow you to get a mindmap that you’ll find helpful to help you fill in some holes.
You may also be interested in information that is at ClinicianBusinessInstitute.com.
Good luck!
Hi Laura,
As you know, when starting a business there are so many moving parts, it’s hard to keep track of everything. Here are a few things that may help.
– Go through this blog – there is a lot of information.
– Download the mind map that is available on this blog. You’ll be lots of things you that may jog your mind.
– Join our public NP business group on FB
– Join NPBO™ where you can get a lot of support and further information
– We have courses that can help you at ClinicianBusinessInstitute.com
– Of course, if you need to do a consultation, we can set that up as well.
Hope that helps.
I WILL LIKE TO START SEEING PATIENTS AND PROVIDING CARE FOR THEM IN THEIR HOME AS AN INDEPENDENT PRACTITIONER. I LIVE IN NY. I HAVE EXHAUSTED SO MUCH TIME TRYING TO FIND OUT WHERE TO START WITH NO LUCK. I AM ALREADY ENROLLED IN MEDICAID AND MEDICARE. WILL SOMEONE BE OF ASSISTANCE IN POINTING ME IN THE RIGHT DIRECTION?
Hi Shirley,
So glad you stopped by. Yes we can help. First, this Sunday, we are having a webinar – Essential Steps to Starting Your Practice. It’s free and you can sign up at http://NPBusiness.ORG/Essential Steps.
Secondly, depending on where you are in your process, you may find some answers by searching the blog, or visit http://ClinicianBusinessInstitute.com. There are a variety of resources that you will find helpful.
I am looking to open a PrEP and STI only clinic in Michigan, how does one find a collaborating doctor and how much pay is expected to pay them?
Start here http://npbusiness.org/collaborating-physicians-part2/, it will also link to part one. It will give you the basics. If you need further assistance, we have a course of collaboration. that will also walk you through what you should have in your CPA. https://www.clinicianbusinessinstitute.com/p/collaboration
I am PMHNP-BC for 4 years and would like to start my own independent practice in New York. I would provide medication management and psychiatric evaluations via telemedicine. I am not sure where to start and need some advise. I am planning on a home office and starting with one day per week. Need some advise. I also planning on private pay and all insurance, since NY now reimburse for NP for telemedicine.
Hi Debra,
Congrats on getting started in practice. The first place to start is with some planning. You may find what you are looking for by searching this blog. Alternatively, you can shortcut your time and energy by joining NPBO™ to get ongoing help, and/or take a course in getting started in your business. ClinicianBusinessInstitute.com
Best wishes!
I am an FNP in California. I have worked as an NP for 7 years and would like to open up my own practice seeing patients. I just am not sure how to go about doing this. Any advice or any direction you could point me in to get started?
Good Morning Lisa, here are a few resources:
Let us know if you have any additional questions.
I am currently working in a private practice and am considering going solo by getting an office suite and working without support staff (keeping my collaborative). To make it easier I would want to do self pay only rather than billing ins, which I know will be a risk for building a patient load. My questions are, do I use the same LLC & tax ID for both offices while transitioning to my own place; and since I’m already credentialed with insurance, can I give patients a superbill to try and get reimbursed?
Hi Brooke,
For YOUR business, you need to have your own LLC (or other appropriate structure). That business will have its own NPI and it’s own EIN number. You will need to get credentialed under those numbers – not your current employers. So you current credentialing will not help.
If you are not credentialed, you can have a cash practice and give patients a superbill so they can attempt to collect from payers. If you are credentialed, you’ll need to follow the terms of your contract with the payer.
Thanks for the questions. Best wishes!
Thanks Barbara! I’m actually an independent contractor at the private practice I’m in, so I’m contracted under my business LLC, not the practice. I wondered if I may just be able to provide the patient with a superbill, but it sounds like if I keep my credentialing, I may need to bill directly.
I am getting ready to graduate soon. I want to start my own business right away. I will be getting my master in psychiatric mental health nurse practitioner. Can you tell me where to start? I live in Apopka, Fl and there is not many of this kind of business around and I want to start but I am stuck. Can you offer any advice on what I need to do?
Lisenie,
I don’t recommend (in most cases, as there are exceptions) that a new grad NP start their practice right away. Most are better off spending time developing their clinical acumen before learning to own and operate their own practices.
That said, there are several articles on this site about starting a practice. Here is one – https://npbusiness.org/the-abcs-of-starting-a-nurse-practitioner-practice/
Additionally, visit ClinicianBusinessInstitute.com for more in-depth assistance.
Have you heard anything on nurse practitioners with an online telemedicine practice? I assume it would lessen the overhead, however can you be paid by insurances? Thanks.
Hi Amanda,
Yes, this is a popular model that NPs have been doing and yes, insurance companies (depending on the plan) are reimbursing.
Barbara
Hi I am starting an np diabetes management clinic in MD. I did market research and noted very limited endocrinology/ diabetes providers in my location. I have Medicare privileges and plan to obtain Medicaid and cash pay and have all credentials.
However I am still not certain about cost scale for cash patients. And since I’m a small, just me, should I do my own billing for now? I’ve heard horror stories related to getting reimbursed from insurance thus why I’ve yet to add others yet. I’m ready to start seeing patients but want to be sure I’ve got a clear idea about the above.
Thank You
There can be horror stories about insurance reimbursement, and most of the time it can work. Building a practice on cash can take longer, but it can work. In terms of Medicare, I am assuming that you’ve gotten credentialed in your business at this point. (Sometimes there is confusion about this).
Hello, it appears that you have been teaching this course for several years. Has the content been updated to reflect up to date information on billing and coding?
Yes!
Hello Barbara – I love this site and all the great info you provide; thank you. I am an experienced practicing geriatric NP and I have been granted autonomous practice in Florida. As a “senior” myself -I recently moved to a large age 55+ community (seniors are getting younger and younger!). I teach senior exercise dance classes and so many of the participants talk to me after class about health needs, etc. I think it would be very helpful to have an NP within the community who they could see readily. I would not take over for their PCP but could act as first stop perhaps since many seniors do not like telemedicine and cannot see their PCP promptly. I’d communicate with the PCP as appropriate, but I wonder about stepping on toes if I prescribe and check labs. I have NPI, DEA, Medicare/Medicaid approved, insurance, etc. I think it would be a flat fee (small so they can afford it) at time of service. Also, how do I know how to set up the medical record (can’t find that info)? Any thoughts on this venue would be most appreciated! Patricia
1. My understanding of autonomous practice in FL is that it is only for those practicing primary care. Has that changed?
2. If you are ordering labs, prescribing can step on toes is it’s more than just an “urgent” visit where you refer them back to their PCP.
3. You cannot charge them for your service if they have Medicare or another insurance that you are credentialed with through your businesses. With Medicare, you can never charge cash for a covered service unless you opt-out (which is global).
HTHs ~ Barbara
Can you recommend a billing company? And some guidance on how to apply for the insurance company. Thanks,
Hello Rebecca,
I cannot recommend a billing company. Everyone has different needs, software, specialities, that it’s hard to do. I’d probably start with my nearby colleagues as to what they are using as well as filtering that for speciality/type of practice. I recommend definitely having a list of questions based on your need, as well as problems people have expressed with other billers.
When you ask about applying for the insurance company, I think you mean credentialing. If so, we do have a course that can easily teach you how to do this and save yourself potentially thousands of dollars and hundreds of headaches. –>> DIY Credentialing.