Whether you are just out of college or you’ve decided to start up a private practice after working for someone else, there is much to be done. I will not try to go over all the things that you will need to open your office, but here is an idea of what needs to be done to get the insurance companies to pay you.

The one thing that they don’t teach in medical school is how to run a business and let’s face it, a medical office is a business. It isn’t as simple as finding a door to hang your sign on and waiting for patients to come in. There is a lot of paperwork that needs to be done prior to opening your doors.

I obviously cannot cover every little thing that needs to be done but I’m going to try to hit on the main things. First of all, once you have picked your location you need to decide if you are going to just be a sole proprietor or if you are going to establish a corporation. The best way to make this decision is to speak to your lawyer and/or accountant.

If you are going to be a sole proprietor you will need to decide if you are going to use your social security number for tax purposes. If you do not want to use your ss# or if you are establishing a corporation then you will need to get a tax ID#. They are easy to get. You can either apply online or call the IRS and get one over the phone. While you are applying for these, don't forget that you will need an NPI #.

Once you have determined what you will use for tax purposes you will need to decide if you want to participate with insurances and which ones you want to participate with. There are many things to consider in making your decision of whether or not to participate with an insurance company.

When you decide to participate with an insurance company, contact each company you are interested in and see what they require from you to begin the credentialing process. Many insurance carriers today are using CAQH, the universal online credentialing application. This is an online application that is quite involved. However once you complete it, it can be used for most credentialing and re-credentialing. You just need to update it with any changes. Some companies will not credential you unless you complete the CAQH application.

When you apply to become participating make sure you ask each company how long the process takes, and if your effective date of participation is the date you apply, or the date they approve you. This is important. For example, Medicare of NY makes your effective date the date you request on your application. This means that even though it takes about 4 months to complete the credentialing process you can see Medicare patients and just hold the billing until you are credentialed. Other companies make the effective date the date that they grant approval. That means if you see any patients prior to that date you will not be reimbursed as a network provider.

When you complete the credentialing process, you will need a signed W9 form which you can download on your computer and a copy of your license that you can easily photocopy. If your license is framed and you must remove it to get a photocopy, make at least one extra copy and keep it for a template. You will also need proof of professional liability insurance.

There are also some forms you should have in place prior to seeing patients. You will need the obvious patient intake form and the encounter form to indicate what services were performed and the diagnoses for the visit.

You also need to have a notice of HIPAA Privacy Practices available for patients and someplace for them to sign stating that you have made them aware of your HIPAA Privacy Practices and that a copy is available for them if they request it.

If you provide services to Medicare patients you will want a Medicare ABN or Advance Beneficiary Notice to advise Medicare patients what may or may not be covered. Depending on your specialty there may be other forms that will be required.

One of the services as a billing service that we offer to our clients is to help providers just starting out to get all this paperwork in place. It is comforting to the provider to know that someone else is taking care of these details.

These are a few things that you will need to consider when starting up a new practice. If you get things in place before opening up it will make things go a little smoother. As I stated earlier this is obviously not everything that you need to do, but I’ve tried to cover most of the main points.

Good luck!!

Copyright 2007 - Michele Redmond