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How to Start a Telemedicine Practice

Many physicians in our online communities for doctors wonder about how to start a telemedicine side gig or how to incorporate telemedicine into their existing practice. While there are many telemedicine companies seeking physician employees or contractors, many doctors feel that opportunities nowadays either pay less than desired or have other issues that make working for telemedicine companies less attractive. As such, many doctors would prefer to have their own platform where they can see patients without the use of a middleman. In this article, we’ll go over the important steps to establishing a telemedicine practice, legal and privacy considerations, and other practical considerations to get started with seeing your own telehealth patients.


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How to start a telemedicine practice


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Why start your own telemedicine company or incorporate telemedicine into your practice


There are so many questions on our physician communities about starting to practice telemedicine, and we’re not surprised. Some common reasons why physicians may want to incorporate telemedicine into their services include: 


  • To provide an added service to existing patients and enhance patient satisfaction

  • To add more flexibility into their clinical schedule and open up potential for either some or all work from home options

  • To make more money seeing patients via telemedicine than they would by working for a telemedicine company, or to avoid red flags increasingly seen in telemedicine opportunities

  • The ability to see patients across state lines

  • The ability to develop a niche practice focusing on a certain area of expertise where a local market may not have enough volume

  • Be able to see patients after hours and bill for visits

  • Decrease some overhead



What should you know before starting a telemedicine practice?


It’s important to note that starting a telemedicine practice is not as easy as putting up a website and spreading the word, although there are certainly companies that are trying to make it easier for physicians to launch telemedicine practices. If you elect to go this route, understand what you may be giving up for the convenience, as some companies will take a percentage of your earned income into perpetuity or have heavy platform fees for something you could easily do on your own.


Additionally, while many love the idea of earning money online, remember that telemedicine isn’t perfect, that there are some challenges in the telemedicine space that you have to navigate, and that there are some risks to going all in on this business model.


For one, the future of telemedicine reimbursements if accepting Medicare or other insurance payors is uncertain. While most people don’t think telemedicine will go away, as of May 2025, there are not permanent telemedicine payment structures in place for Medicare across all use cases, and Congress has only been extending the payment structure enacted during the pandemic for short periods of time. If this were to go away, most insurers may follow suit, threatening to cut down or even eliminate payments.


Next, it’s important to know what your target patient population is, and whether they will be open to adapting telemedicine, as well as whether you can safely assess patients virtually and offer treatment plans without a physical exam. If you have a predominantly elderly population, for example, they may not be adept at using technology. Make sure you do your market research before committing to this route.



How do you start a telemedicine practice, step by step?


1. Establish what type of telemedicine practice you want to build.


It’s important to understand who your target audience for your company is, including:

  • Cash pay versus insurance based

  • Age and other demographics

  • Synchronous (telemedicine done in real time with live interaction) vs asynchronous (patients submit information which you review on your own time, such as review of images, requests for prescription, or lab results)



2. Put together a business plan and proforma, and budget accordingly or secure funding.


Every business needs a plan in place for how you’re going to make money. You’re going to want to do a thorough analysis of the costs associated with your practice as well as create a go-to-market plan to acquire the target patient population that you established. You may need to take out a small business loan if you don’t have enough money saved up - not just for the start up costs to your practice, but to cover your expenses while your practice is in the start up period and slower.


Not all of these costs are relevant to telemedicine, but review our article on creating a budget or proforma for a private practice. 




3. Understand the regulatory and legal requirements associated with establishing a telemedicine practice in your state, and establish an entity.


It’s important to structure your telemedicine business properly, and you should consult with a healthcare lawyer in your state for state specific requirements and considerations and for help as you navigate the appropriate entity structure (LLC, etc.). 


Some states won’t allow you to establish care for the first time via telemedicine, and prescribing laws can also vary from state to state depending on the medications.


If you’re going to accept insurance, you may need a physical address in many states. If you’re doing this through your private practice, this may be less of an issue, but if you need a virtual office or similar, you’ll want to get that set up.


Make sure that you have a private place to do your telemedicine visits or review patient input to stay compliant with HIPAA. You can also  check state-specific laws about telemedicine via your state medical board. If you need consent forms specific for treatment through telemedicine or other related patient intake forms, get these drafted. 


Explore our healthcare attorney database for local help in your state.



4. You will typically need a license in every state that you intend to provide telemedicine services in.


As a general rule of thumb, you’ll need to make sure you are licensed in the state where the patients you see are physically located in. There are some exceptions and waivers that can apply, but typically, this will be required. This may mean that you need a lot of state licenses.


If you need assistance obtaining multiple state licenses, contact our licensing services partner, BlueShift Licensing. They offer concierge assistance, do licensing in all US states, and do the majority of the work so you can focus on the many other tasks associated with starting your practice. The founder, Jen, is highly experienced and has helped so many physicians and companies get their licensing completed efficiently. Email Jen at jen@blueshiftlicensing.com to get started. Mention PSG for 10% off of licensing and credentialing related services through our advertising relationship.


Learn more about medical licensing.



5.  Ensure that you have malpractice insurance that covers telemedicine.


You’ll need appropriate malpractice insurance. Don’t assume your malpractice insurance from your employer or private practice covers telemedicine. 


If you need help securing malpractice insurance for telemedicine, AutonomyMD partners with physicians to provide access to an affordable, subscription based malpractice insurance. For $150/month on an annual contract, get a PSG special perk of 30 visits (up from 25) per month and a HIPAA compliant app to document visits. Sign-up through our partnership form to receive the exclusive PSG perk.



6. Choose a telemedicine platform that you will use to see patients.


You will need a HIPAA compliant platform. There are many of these to choose from, and you’ll want to consider:

  • Cost

  • Quality of the audio and video

  • Reviews from other physicians

  • Ability to process payments

  • Ability to send prescriptions

  • Integration or ease of working with your chosen EHR documentation solution 

  • Internal scheduling platform or ability to integrate with your chosen method of scheduling appointments

  • Waiting room features

  • Support of on demand visits

  • Will patients have to download a separate app or can they use a web browser?

  • Consent capabilities

  • How many people can simultaneously be in a visit (in case a loved one wants to join the call or if you may want to consult with a specialist)

  • Review of third party audits for HIPAA and HITECH compliance


If you are doing this within the scope of your private practice, your existing EMR may have built in telemedicine capabilities.



7. If you are an insurance based practice, do credentialing and contracting with Medicare and other payers.


You will likely have to apply as a telemedicine provider, and you’ll want to understand how much each code pays for telemedicine. You’ll want to get familiar with relevant codes and modifiers. Learn more about credentialing and contracting.



8. Create a website so patients can find you.


You’ll want an SEO optimized website with features that allow you to build your practice over time, including the ability to take payments, schedule appointments, fill out forms, learn about your pricing or payment models, and more. Creating a blog may help more patients find you as well.


Related PSG resources:

  • GMR Web Team offers a comprehensive suite of digital marketing solutions for physicians, including SEO, content creation, website design/management, and more. GMR can help you build a strong online presence, cultivate patient loyalty, and achieve sustainable growth for your practice. PSG members receive 20% off blog writing services, website design, and website hosting when they sign up through our affiliate link.

  • Artillery designs attractive websites that are pretty reasonable in price (usually $2,000 to $5,000 depending on complexity). They have helped numerous physicians in our community. Mention PSG for an exclusive $200 off a website custom designed for your private practice.




9. Make sure you have the right technology to do telemedicine.


You’ll likely need good lighting (or a good ring light), a quality webcam, a secure high speed internet network, and an EMR platform, if not included in your telemedicine platform.


Here's some of the equipment our PSG team uses that could be used in your telemedicine setup:




10. Start marketing your services and seeing patients!


It’s time to start marketing! You may want to use social media, your existing patient base, or referrals from colleagues. Let people know this is a service that you’re offering. If you’re in a niche market where your expertise is unique, make sure you leverage that and create content that exhibits thought leadership.


Learn more about marketing your practice.



Conclusion


If you’re interested in incorporating telemedicine services into your existing practice or creating a standalone telemedicine company or service, hopefully this article gave you an overview of what you’ll generally need to do to get started. As stated, there are nuances to each of these, and laws vary amongst states, so it’s very important to speak with a healthcare attorney in your state to get appropriate guidance so that you can stay in compliance and avoid unpleasant surprises along the way. Good luck!



Additional telemedicine resources for physicians


Explore related PSG resources:

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