Practice Startup Questions and Answers

Not too long ago, we held a webinar on Starting Your Own Practice for nurse practitioners and other clinicians. Unfortunately, too many people could not get on the webinar as we maxed out our platform and others missed signing up.

Because of this, I thought I’d share the some of the questions asked on the webinar via a short video.

Here are the questions:

  • Situation: A Medicare HMO patient is seen as a cash patient at the families request. The NP is not in network, but is credentialed with Medicare. Can she collect cash payment from this patient?
  • If you are a cash-only business can you accept Medicare/Medicaid patients and have them pay cash or is this illegal?
  • My biggest concern is billing Medicaid and Medicare. How do you ensure you do not run into fraud unintentionally? Are there any links or classes that Medicaid offers?
  • Is it possible to obtain a practice insurance to cover self only (professional liability insurance) and business later? I’m having a hard time finding a company to offer that. Saying they have to cover the business too.
  • Do you have any recommendations on how to find a CPA and attorney?
  • What is better LLC or PLLC or S-Corp or C-Corp?
  • I will be 60 years old, is this worth the time and effort?
  • Is there a manual for the step by step process to starting a clinic?
  • Credentialing with CMS is a very painful process, agencies that do this charge a lot of money. Any suggestions?

If you have additional questions or comments, please leave them below.


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  1. Question: My collaborating physician is throwing a fit because I do not have him labelled as the PCP on my patients. I started a House-Call practice in Texas a few months ago and might have missed that learning session. He will be scheduled to see the patients as time comes but so far, I am the provider seeing the patients. According to Medicare guidelines for home care, he signs the POC and supply orders. Do I label him the PCP (which in my case is- primary care provider) or what am I doing wrong?
    Thanks for answering

  2. I forgot to mention that the patients POC have his name on them and he just wants me to label him the PCP in EHR.

  3. Hi Linda,

    Unless there is a requirement to do so (and I’m not aware of one, but double check your state laws), I would not name him as the PCP. Doing so would increase his liability and responsibility for the patients – so I’m not sure why he wants that. I’m not familiar with anyone who has a physician labeled as the PCP in their EHR for house calls.

    The POC is another animal…and Medicare requires the physician to be listed.

    Thanks for stopping by and good luck!

  4. Thank you for an informative video. If I’m already credentialed with the hospital i worked for the past 8 years and I’m starting my own private practice as part-time, do i need to go through credentialing again?

  5. Yes, you will need to get credentialed under your own business. Some insurance companies will just add your business, so you’ll need to contact the different payers. Make sure you’ve already created the legal structure for your business with all appropriate numbers (NPI, EIN, etc). Good luck!

  6. I am from Illinois and was told by my attorney that I do not require a physician owner, but a friend of mine who opened her own clinic 3 years ago was told she had to. Does anyone have any insight where I can look in to this further or know the information?

  7. I would like to start a free clinic service in my rural community. I live in Missouri. Where do I begin. Thank you so much for the help

  8. I am a graduate FNP in NY and I would like to start practicing right away with my husband in his chiropractic office, would I still need to have a collaborating agreement with a physician in order to start seeing patients in this setting? Any advice on getting started with practicing in this specialty?


  9. Hi Theresa,

    Congrats on this endeavor. MO is very short of providers in the rural areas. However, regardless of the type of clinic, you want to start you need to start with assessment and planning. In this case, it’s vital you plan out revenue and expenses. Regardless if you have a “free clinic”, it’s not free.

    What else do you need to do? Look through the blog for further information on starting a practice. You can also consider our NPBO™ Startup Course for complete A-Z assistance.

    PS: As a side note, please consider using the term “sponsored care” instead of free. It’s important that we are more accurate for ourselves and our patients…and there is no such thing as free.

  10. Hi Barbara,
    I work in 2 different clinics providing regenerative therapy in Southern California using PRP and CT products (joint, IM and IV injections). One collaborative MD is a urosurgeon in Florida (that I never met) and another office in southern California but the collaborating MD is in northern California.
    Now I m ready to start my own business. As Im about to start serious planning, I got confused about the scope of practice of NPO in California. the Attorney (who happened to be a NP as well) shocked me saying I am liable practicing this way (especially with the MD in Florida) however, the California BRN does NOT clearly state the proximity of the collaborating MD (it mentions reachable by electronic means (texting)).
    Currently I have a primary care MD signed my collaborative agreement (he is in Southern California and close to me), can I proceed and have my own regenerative health clinic ?? thank you

  11. Amjad,
    The California “scope of practice” is vague, as are some of its rules. However, I’m going to agree with the NP attorney you spoke with. In almost any state you are walking a tightrope with a collaborator who is out of state and who you have never met. Not a good idea.

    In terms of your primary care MD, would he be outside of his SOP to work with an NP in an area he does not work in?

    It’s important to always be aware of what the rules say about business and collaboration from all the stakeholders. And there are plenty of rules for CA.

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