What you need to know about: 

Starting and Running a Private Practice 

Although so many physicians like the idea of owning their own businesses, even thinking about the numerous steps to set up a private practice can be overwhelming!  This page is intended to serve as a repository of private practice related resources (including perks!), answer FAQs we often see on the groups, and give you some pearls.  

*Please note that every practice is different, and that you should consult related expertise before making any decisions based on these resources, which are only intended to be educational and help develop a framework from which to explore deeper.*

Frequently Asked Questions

 

Checklist on How to Start A Private Practice

Considering opening up your own private practice? Prepare well in advance to set yourself up for success.  While the process is time and resource intensive and will require a willingness to learn and get your hands dirty, you can make it easier by leveraging the expertise of your colleagues and vendors.  Start by establishing the big picture and ensuring viability, and then take a step by step approach (some steps may take longer than you think, so plan accordingly). 

Here’s a broad overview list of your priority steps:

  1. Business Pro Forma

    1. What is your business model? Insurance-based or other?

    2. Who is your ideal patient population? 

    3. Analyze the competition to determine the need for your services: wait times, practice type, volume, reviews.  SWOT analysis on your practice model.

    4. Financial analysis/budget. At minimum, determine start up costs, year 1 expenses, and expected revenue

      • Major expenses: lease, equipment, payroll, software/technology, vendors

      • What do you need to generate to break even?

      • 1 year, 3 year, and 5 year conservative projections for revenue

  2. Location

    1. Determine location most accessible to the target patient population. 

      • Heavily research patient demographics, payor mix, local competition, proximity to referring providers and hospitals.  A consultant can help you.

      • A commercial real estate agent can help identify potential spaces

    2. Certificate of Occupancy to use the space (need fire, safety, and city inspections)

    3. Furnishings, signage, equipment, utilities, and/or potential rehab for space

  3. Secure your financing and documentation

    1. Financing - line of credit and loan to cover at least 120 days of initial expenses. 

    2. Accounting - EIN/tax ID, business accountant, bank account, credit card 

    3. Entity structuring: Healthcare attorney, articles of organization/incorporation

  4. Staffing

    1. Practice manager: most important/first hire, ideally with past practice management experience.  Oversees strategy/execution and hiring.

    2. Medical assistant, nurse, technician, front desk, etc.  Stay lean as possible.

    3. Employee management - Policies and procedures manual, HIPAA, OSHA, Stark, CLIA, Universal Protocols, Disaster response, Harassment training

  5. Vet potential vendors/services as applicable.  

    1. Payroll services

    2. Billing/Coding/Compliance

    3. Information Technology (data backup and storage, phone lines, internet)

    4. Website/social media/SEO/marketing

    5. Electronic Health Record

    6. Practice management software

    7. Cleaning/groundskeeping

    8. Credit card processing

  6. Credentialing/logistics

    1. Get your state license - this typically takes longer than you think

    2. Group NPI/DEA/Medicare provider numbers

    3. Get credentialed at your local hospitals

    4. Apply for insurance and Medicare/Medicaid coverage

      • It is likely if you are on your own you’ll have little ability to negotiate private insurer contracts

    5. HIPAA and MACRA compliance

  7. Insurance/Benefits

    1. Malpractice, Health, Disability, Life, Business/Corporate/Workers Comp, and Umbrella Insurances

    2. Other employee benefits such as retirement plans; ensure legal compliance

 

Private Practice Resources (and Perks!)

  • Credentialing/Revenue Cycle Management/Billing and Coding
    • Cosentus​ is an advertiser and has been reviewed highly by several physician clients that we spoke to who are currently using their credentialing, billing and coding, revenue cycle management, and accounts receivable services.  Fill out this form for a free professional billing and coding review as well as 5% off services with the code PSG5OFF. 
    • Billing and coding: what you need to know primer (free)
    • Medical Billing and Coding Course: This course goes over the basics and complexities of medical billing and coding for a very reasonable price of $249.  You can get an additional 10% off by using our affiliate link and then entering promo code 'sidegigs' at checkout. 
  • Virtual Assistants/Scribes/Employees: Edge Health provides college educated remote employees that work full time for your practice.  They perform tasks such as primary or secondary phone support, billing, claims, insurance verifications, scribing, social media, and other tasks.  Practices tend to use the services in multiple different ways.  They are trained prior to starting in your office, and the cost is substantially less than what you would pay an in-house employee. Please click here to learn more about Edge's services and schedule a demo, and receive $250 off your first two months through our affiliate link at https://edgehealth.co/physiciansidegigs/
  • Credit card processingSquare - hardware discount and an opportunity to explore lower processing fees through our group affiliate link
  • Payroll/Benefits: Gusto (affiliate link) has been highly reviewed by many of our members, and includes options for benefits.
  • Websites/SEO:
    • Artillery - attractive websites that are pretty reasonable in price (usually 2-5k depending on complexity). Mention PSG for $200 off.
    • Squarespace - really easy way to create websites with stylish templates yourself.  Mention code PARTNER10 for 10% off through our affiliate link at squarespace.syuh.net/AoEXDD
  • Clinical research: Add an income stream to your internal medicine, GI, or neurology practice through SiteRx.
  • Malpractice and Tail Insurance: Jason Shah (Jason.Shah@aleragroup.com) is a physician who started a malpractice company that is now under the umbrella of Alera Group.  He's great and has helped many members of the group. We do have a referral relationship so please let him know you are coming from PSG if you reach out.   
  • HIPAA-compliant eSignature solution: SignNow
  • Business cards and other print advertising materials: Moo I get asked about these every time I hand them out.  They are visually appealing and memorable.  25% off your 1st purchase through our referral link at https://refer.moo.com/s/nishamehtamd.
  • EHR, Retirement Plans, Insurance, Scribes, and more coming soon.

 

 

Initial Logistics

    •  You need a legal name, so that you can do all the other things.  Although you can name your business whatever you want, people often include their specialty, region, and/or name.  Make sure there is not another company with the same or overly similar name in your state.

    • Once the name is ready, purchase a domain name so that it doesn't get taken.  Even if you plan on having someone else build the website, owning your own domain is a good idea.  You can also get an email address up and running related to the domain, or use a generic email account.

    • You'll need an address.  If you've found your practice location, that's great.  Otherwise use a UPS box or other address (note, USPS PO boxes will not work for credentialing or bank accounts). 

    • Set up your LLC.  For something as big as a practice, you may want to get legal consultation to make sure you do it right, especially if there is more than one owner.  

    • Get a TaxID/EIN number (guidance here).  

    • Get a phone number.  You can get a Google Voice number, which is free, but also has the ability to add a HIPAA compliant option for texts through Google workspace.

    • Get a fax number.  You can use Doximity for free or use a paid e-fax provider if you anticipate more volume.

    • Set up a Group NPI number (different than your individual NPI).  You can do this here.  

    • Set up a bank account.

 

 

Credentialing

Credentialing is the process of getting on insurance panels so that you can accept payments from patients who have that insurance.  This process can take a while to be finalized (usually 90-120 days, but expect up to six months), so initiate the process well before you start seeing patients.  Each application is time consuming, involving submitting the application, as well as often times ensuring they’ve received the application and following up on the status of the application.  Many say they have to resubmit applications, submit further information or contest decisions, and spend a lot of time on the phone.  Sometimes, insurance companies will state that they are full and not accepting physicians of your specialty in your location, and you will have to monitor carefully for openings to come up.  If you need help with credentialing, you can use a company such as our advertisers at Cosentus.  Fill out this form for a free professional billing and coding review as well as 5% off services with the code PSG5OFF. 

  • Decide which insurance companies you want to be credentialed with, based on who the major insurance carriers are in the region.  You don’t have to get credentialed with every single insurance company off the bat, but will want to at least get the major carriers on board so that you can see the largest number of patients from the start.  An easy way to figure out who the biggest insurers are in the region is to see what insurances the other practices in the area accept.

  • Prepare your documentation and complete your CAQH

    • CAQH (Council for Affordable Quality Healthcare) is a database that serves as a repository of credentialing information used by insurance companies and others that need credentialing information.  These companies pay for access, but you do not. Importantly, this will not preclude you from having to do an application, just from having to submit individual documents.  Not all payers use it, but the majority of the big ones do. 

    • Insurance companies require a lot of documentation, and much of it is repetitive from one company to the next and needs to be kept updated.  Examples include CV, W9, board certification, diplomas, proof of malpractice, state licenses, DEA and CDS (Controlled Dangerous Substances) or equivalent certificates, and proof of hospital privileges. Your CV has to be in the correct format, with month/year, or it will be rejected, and there can not be gaps in employment history so make sure all dates are accounted for.  If you keep the documents uploaded in CAQH and update them regularly, the insurance companies that do participate in CAQH can directly access those documents, saving you a lot of time and energy. Note that you will regularly have to attest that the information is accurate and up to date. 

    • You will need three references.

    • You will need information about your practice entity, including legal documentation/articles of organization, address, the Tax ID number, group NPI, and your NPI, as well as office hours, phone number, and fax number.  If applicable, you’ll also need billing company information and contacts for billing and credentialing.

    • Submitting your CAQH profile:

      • You can set up your CAQH profile at https://proview.caqh.org/pr/registration/selfregistration.  If you are currently employed, your employer likely already has a CAQH on you, and you’ll have to request your CAQH ID#, login, and password from your human resources department.  While there is a paper version, it is long and cumbersome, and has to be manually inputted by someone, increasing the chances for delays or paperwork getting lost.

      • Grant access to the payers by signing and dating the provided attestation form, and uploading the document.

      • Regularly check your profile every 60-90 days to make sure everything is up to date.

  • Credential with each insurance company.

    • Expect at least 10 hours per company including getting the application (in a lot of cases, you will need to print the application and complete by hand), organizing the information/documentation, and submitting the application, as well as following up with the company by phone.  It is generally recommended to call the insurance company after you submit documentation to ensure they got it and that there are no issues to avoid the application being in limbo and potentially expiring, thus starting the timeline again.  Many people also say to call the insurance company every 2 weeks thereafter to check in on the status.  You should ask to speak to provider relations and establish a contact person at the company who you can speak to directly and start forming a good relationship with.  You should then follow up your conversations with an email to ensure a paper trail.

  • FAQs:

    • How long will it take?  Usually 90-120 days, but it could be as long as 6 months.

    • Should I assume I’ll get credentialed?  In most cases, although some insurance companies require being licensed or practicing for a certain amount of time before you can join their panels.  Sometimes, the panels will say that they are full.

    • What happens if a panel says it’s full?  Call them and pitch them on why they want you on their panel - emphasize what you bring that others in the area don’t offer (offering pediatric or underserved options, extended office hours or weekends, speaking another language, performing niche procedures, etc).  If all else fails, keep calling back to check for openings.

 
 

Contracting

Contracting is different than credentialing.  This is where you actually negotiate reimbursement and terms with the insurance companies.  Once you've passed through the credentialing process, the insurance company will send you a contract that includes the "fee schedule" that they propose, in which it is stated how much you will be paid for each service.  Before you waste your time on the fine print, start with the compensation information (usually located at the end), because if the numbers don’t make sense, the rest of the contract will change throughout negotiations, or you may just elect not to go forward.

Know that even with the same payer, they will have several different fee structures, and what they will offer you will likely depend on what they think your negotiating power is and what their need for you is.   They may not pay you what they are paying your friend down the street. Similarly, you should research the competition and compare fee schedules from different companies, even if you’re not planning on using that insurance company for one reason or other.  Understand which insurance companies have which payor mixes and different types of plans (Medicare, Medicaid, Medicare Advantage, HMO, PPO, etc) and what other physicians or hospitals are in the network for referrals. In most cases, you can’t pick and choose the lines that you are contracted with, so assume you will have to accept all of their plans.  If you have concerns about particular lines, ask about them and what, if anything, can be modified. If there are certain medications or services you routinely provide, ask about their formularly restrictions or preauthorization requirements. The more data you have, the better.

It’s also very important for you to decide whether the proposal makes sense.  Don’t just decide you are going to take it because you feel that you have to be in-network.  You can also decide to be out of network, or decide to negotiate.  Your goal is to work smarter, not harder, and you should run the numbers for different scenarios.  Decide the point where more patients and volume isn’t worth it at a lower reimbursement rate, and it’s better to have fewer patients reimbursed at a higher rate or to leave time in your schedule for something that pays better. 

When you’re first starting out or if you’re a solo practice, you may not have much room for negotiation, but you should of course try to get yourself the best deal possible.  Understand that the rate you lock in at initially will be the rate you will be stuck with for a few years, and also understand it will be the starting point for negotiations at the next round, so whatever rates you agree to will follow you. Therefore even a small increase will justify the effort over the long run.  

 

When you negotiate, you can ask for a conversation with the payer.  It is very important to come into that conversation prepared, so that you can most effectively advocate for your worth.

 

You should know what things make you attractive to the insurance company.  If there are things that you can offer that nobody else in the area can, mention those things (specialized expertise or training, procedures that others can’t do, languages that you can speak, better patient satisfaction, large patient base, dominant brand, etc).  If you know there are things they will try and use against you (e.g. nearby competition), be prepared to counter those with numbers. 

After the conversation, they’ll usually have you put your asks in writing.  This is good because it will create a document that can be passed between various people at the company as well as a record of correspondence.  This document should be written at a lay person’s level and include:

  • Information about you - basic demographic information, where you’re located, who your patient base is, which hospitals you’re credentialed at, specialty and board certifications

  • More specifics about your practice: procedures you do and codes you use, any subspecialty focus or interests.  

  • Any other factors that make you unique.
     

Be very organized in these negotiations.  Clearly document everything that’s agreed upon, the person who agreed to it, and the date they agreed to it on, so that you can ensure that it ends up in the final contract.  Take lots of notes about the discussions, what was used against you, and what worked for you, as they will help you when you renegotiate contracts in a few years.

You’ll also want to assess the term, conditions for termination and renewal, and how the claims will be filed and paid.  Most plans will not let you terminate your participation until a certain amount of time has passed, and will require a certain notice period.  Know if either party can terminate without cause or if there is an automatic renewal clause.  If you terminate, what will your obligations to the patients be?  You will also want to understand details of payment timelines such as how long you have to submit a claim, what classifies as a late payment, and what happens with overpayments. Are there any nuances or caps for payments?  What data is the RVU value being determined from?

As you read through the contract, read every word (don’t skim!), track changes and take notes about possible concerns or questions.  Red line your changes and insert the exact wording you prefer.  Make a copy before you send off the document, send the letter via certified mail, and then follow up to have a phone conversation with your contact at the payer. Good negotiation skills and demeanor will get you far.  While nobody will care about the process as much as you do, if you don’t trust yourself to do the negotiations or don’t have the time to do it with every payor, you can outsource it to a billing company.  This will likely cost a few thousand dollars, but again is a fixed cost that will pay itself off if the alternative is not negotiating.
 

When the time comes to renegotiate the contract, repeat the exercise of listing what has changed about your practice that makes you attractive to the insurance company.  How much has your practice grown?  Do you offer new services?  Has the competition changed? Standard contract increases are only a few percent, if any, so if you want something higher, you’ll want to be persistent about declaring your worth.  

Hiring a Practice Manager and Staff

Your practice manager is your most important, and your first hire.  They are going to be the one to handle or oversee everything, including human resources and staffing issues, payments, relationships with vendors, hiring and firing, and marketing.  It is critical to find someone with the right skill set to do this and someone that you get along with well, as you’ll be working with them quite closely.  Important qualities will include:

  • Experienced (ideally 3-5 years).  Especially if this is your first time starting a practice, you want someone with substantial previous medical practice management experience.  They need to anticipate the problems you don’t know to anticipate, and be able to draw upon prior experience to deal with them quickly. 

    • Vet them carefully and check references.  Ask what tasks they took care of in previous roles.

  • Strong people skills, compassion, flexibility, and adaptability.  The practice manager needs to get along well not only with you and the other physicians, but with your staff, your vendors, and your patients.  They should have a personality that is approachable and be well-spoken and mature enough to control emotions in difficult situations.  You do not want your practice manager to be the reason you lose staff or contracts.  

  • Organized and detail oriented. The right person is going to need to multi-task and will be overseeing lots of small details.  In order to make sure the ball doesn’t get dropped on marketing, payments, billing and coding, and other critical day to day functions.

  • Has authority but also has the ability to delegate.  The ideal practice manager will be adept at empowering the rest of the staff to take ownership of projects or tasks.  As the practice grows, it will be harder and harder to keep an eye on everything.

  • Negotiating skills.  The practice manager will be dealing with vendors, staff, and patients and all the complaints and concerns they have.  They should be able to politely but firmly enforce rules or procedures when necessary.

 

Once you’ve figured out your practice manager, you’ll move on to the other hires.  You’ll have to decide exactly how much staff that you need.  Start as lean as possible.  Remember people can have multiple roles, and this is actually beneficial so that they can cover each other if someone is out sick or on vacation.  As you scale, their roles will become more specialized.  

 

At a minimum, you will likely need a front desk staff member/scheduler and a medical assistant.  At the beginning when things are slower, they can also help you with things like social media, scribing, or cleaning up between patients.  Depending on your specialty you may need some specialized staff like an ultrasound or x-ray tech, a nurse, or a phlebotomist.  You will need to make the decision about whether to keep billing in house or outsource to a billing company. Be intentional about your decision with billing, as this is what will keep the lights on, so if you decide to keep it in house, make sure your staff can keep up with timely submission of claims as well as follow up of denials. 

 

Also know there are various ways to outsource some of this if you want to stay lean. You may be able to outsource some staff through a hospital, MSO, or billing company, or share resources with another small practice.  You could use virtual employees through a company like Edge Health.

 

Now to the hiring process.  You’ll first have to look at how many hours each person will be working and decide whether it makes sense to have them as hourly employees or salaried employees.  Typically, office staff and MAs are usually paid hourly, while other medical practitioners and the practice manager are salaried.  Research what other practices are paying for these positions in your area but looking on job sites and postings, or asking around.  Then decide salary rates and what kinds of benefits you’d like to offer.  Is there a bonus structure?  Are you going to have retirement plans?  Is there paid time off, and if so, how much?  Is there an ability to work from home some days?  What will a typical day look like and what will the exact responsibilities for each position be?  Prospective employees will ask these questions, and you want to instill confidence that you know what you’re doing and that you’ll be a good employer.  At the same time, they should know they’re helping launch a new practice and they will be expected to be a team player and get their hands in the weeds.

 

You can advertise the jobs via local job boards, community resources, word of mouth through friends and family, or in advertising for your upcoming practice.  Cast your net far and wide, but be specific about the job description to avoid spending time on leads that won’t work.

 

Have a contract ready to be signed so that when you meet the right people, you can take action quickly.  Many hourly employees are looking for immediate availability and will not wait weeks for a contract like we are used to with physician job searches.  Make sure the contracts or onboarding process include confidentiality agreements and non-disparagement clauses.

 

You will also have to have some basic human resources like an employee handbook that delineates staff roles and personal policies.  Things that should be included in your employee handbook include medical office policies such as work hours, attendance at office meetings, break policies, PTO, benefits, how payroll is handled, how performance will be assessed, and how disciplinary issues will be handled.  These should all be compiled and given to the new employees during the hiring and orientation procedure.  

 

You will also need some additional compliance materials that will offer you protection as an employer.  Have a method for storing personnel files.  Make sure everything is in compliance with ADA, Federal Equal Employment Opportunity (EEO) Laws, Age Discrimination Act of 1967, Fair Labor Standards Act, Equal Pay Act, and FMLA.  Training should include modules on all of these things as well as training for things like practice protocols, disaster response, cultural sensitivity, and harassment training. 

 

Lastly, your employees will need a way to get paid.  You can either do this through your accountant or use a payroll service like Gusto.

 

Choosing the Location of Your Office and Preparing For Opening

  1. Where does your ideal client live?

  2. Is there a need for extra physicians in your field in this area?  If not, what will set you apart from the existing competition?

  3. Do you want your own space from the beginning or do you want to rent space from another practice, retiring physician, etc temporarily to limit costs?

  4. Hire a commercial real estate professional to take you on tours of vacant office spaces. Consider:

    • Where would your practice get visibility?

    • Is there ample parking?

    • Is there room to grow as you expand?

  5. Next legal/accounting steps will likely require a medical office address for necessary paperwork/applications, so you’ll have to secure a location. 

  6. Run lease by a real estate lawyer, and secure the lease.

  7. Furnishing the building - do you need an interior decorator or a contractor?

    • Front desk

    • Exam rooms

    • Back office

    • Needs chairs, tables, decorations

    • Equipment and medical supplies

      • Try and limit overhead at first

      • See if you can get heavily discounted or even free from other medical practices, retiring physicians, or hospitals in the area

      • Exam tables, stethoscopes, otoscopes, blood pressure monitors

      • Ointments, gloves, scalpels, syringes, gauze, antibacterial wipes, tongue depressors

    • Hardware: Fax machines, computers, phones, credit card machines

    • Clothing: Lab coats, staff uniforms, name tags, patient gowns

  8. Certificate of Occupancy

    • Fire Inspection

    • Safety inspection

    • City inspections

  9. Utilities

    • Phone/internet

    • Electricity

    • Water

  10. Landscaping

  11. Signage

 

Choosing an EMR

These days, there are lots of options for EMRs, each with their own features, pros and cons, and price points.  Understandably, making the decision about which to choose is perplexing and time consuming.  While it’s tempting to make a decision purely based on cost, it’s important to remember the most likely, the actual most important factor is that you pick the system that maximizes your team’s productivity (and by extension, your revenue).  

 

Given these things, sit down and list what your needs are.  Think about the daily workflow in your practice or if you’re starting a new practice, that of previous places you worked.  Think about the things that detracted from your productivity, the features you wished you had, the complaints that you and your colleagues voiced, and the features you and others appreciated about the EMR. 

 

Also, remember that your entire practice will be interacting with this EMR, so it’s important to get their perspectives on the software as well.  You will want to consider things like ease of scheduling, automation features, the patient portal experience and relevant patient resources or notes, ease of charting, whether you need a cloud based system that can be accessed from outside of the office, integration with other systems such as labs, hospitals you admit at, and e-prescribing, the ability to customize templates and other functionality and integrate results into notes without having to copy and paste or type, and aiding in billing and coding. Some systems will have time-saving features like the ability for patients to schedule, patient notifications, ability to communicate with pharmacies, integration with patient handouts and necessary notes, and integration with billing and coding and Medicare platforms.  You’ll also want to assess how intuitive the system is, as this will minimize training time and frustration.  

 

Be organized as you assess these features, and take note of things like how many clicks and popups you encounter in commonly used processes, how easy it is to create templates and macros, how long it takes to complete a typical note, and how much time you spend going back and forth into new portals or signins.  You will want to assess how easily you can access the patient’s history of prior visits, workups, labwork, imaging, etc.  Are notes prepopulated for you? While a lot of vendors will tell you their average number of clicks as a selling point, it’s also important to assess loading times and ease of use and customizability for the various menus and screens that may be necessary to navigate through.  Are there easily accessible shortcuts on the keyboard or via dictation? Time is money.  

 

Remember that in some cases, you or your staff will be entering information in front of the patient, and you want that to be as seamless as possible so that you can spend more time looking at your patient and less time charting after hours.  This will also translate to a better patient experience, which will help you to grow your practice’s reputation.   

 

Additional things to consider are how much the system helps you to do your job better.  Does it alert you of possible drug interactions or allergies in a helpful way?  Does it actually facilitate increasing your reimbursement? Recent changes are confusing to many, and some EMRs will actually provide suggestions about what you need to qualify for higher levels of service or suggest codes based on your documentation.  Having a patient friendly portal will allow your office to communicate more efficiently with your patients without the extra time on the phone, phone tag, as well as send important screening reminders or education which could improve patient care.

 

Once you’ve assessed all of these things, revisit the list of needs you created initially and decide what things are essential, what things are nice but not necessary, and what things you absolutely can’t stand. Take the ones that are dealbreakers off the list, and list the remaining options in terms of most ideal to least ideal.  

 

Now, pick a few candidates that would work and start negotiating!  Remember that while price is a huge factor, other negotiating levers to pull include added functionality/features, price locks for a certain time period or free months, added users or training, etc.  If you can, try and time your purchase with the end of a quarter or fiscal year, as just like car salespeople, the sales representatives may have bonuses they want to hit based on closed sales.

 

Payments: Billing and Coding, Banking, and Accepting Payments

Billing and coding is an extensive topic and discussed in more detail here

 

For basic banking, you are going to want a relationship with a bank, not just for your business banking accounts, but also for things like lines of credit, practice loans, or other issues that come up in your life as a small business owner.  Smaller banks tend to be more flexible and provide better service, and therefore you’ll often see people on the groups highly recommending these over the larger national banks.
 

Patients need an easy, secure, and convenient way to submit payments, different payors may have different ways of paying you, and you will need a secure way to submit payments to your vendors.  You should have your own business credit card - make sure you pick one with perks, given that you'll likely be spending a lot of money on it!
 

Most patients will pay their co-pays, co-insurance, deductibles, or cash for uncovered services via credit or debit card, although some may still pay via cash or check.  You will have to decide what mechanism(s) you want to accept.  Credit card fees can get expensive, so it’s important to shop around and negotiate!  When you don’t have much volume, it may be hard to get competitive processing fee rates, but as you grow, you should regularly renegotiate with your payments processor for lower fees.  Our partners at Square will allow you to do this.

 

An additional thing to keep in mind is that unfortunately, for in network payments, you may not be able to pass on credit card fees because you have to paid exactly at your contracted rates. 

 

Marketing and Social Media - coming soon.


 

Now, pick a few candidates that would work and start negotiating!  Remember that while price is a huge factor, other negotiating levers to pull include added functionality/features, price locks for a certain time period or free months, added users or training, etc.  If you can, try and time your purchase with the end of a quarter or fiscal year, as just like car salespeople, the sales representatives may have bonuses they want to hit based on closed sales.

 

Setting up Your Practice Logistics 

Terminology and concepts to know

  • Variable versus fixed rates: Both private and federal loans can be variable or fixed (for federal it will depend on when they were originated; all federal loans since 2006 are fixed.  For fixed rates, the interest rate remains the same for the life of the loan, whereas for variable rates, they will fluctuate either up or down depending on economic and market conditions.  Many loans have a cap on how high variable rates can go.

  • Subsidized versus unsubsidized: With subsidized loans, the government pays the interest while in school or deferment, whereas with unsubsidized, interest will accrue regardless.  All private loans are unsubsidized. 

  • Capitalization of Interest: With student loans with large balances, it is often true that your monthly payments don't cover the interest accrued.  What happens to this unpaid interest is important.  If it doesn't capitalize, it just builds up but doesn't accrue interest, whereas if it does capitalize, it gets added to your principal interest and you are responsible for paying interest on your interest.  Federal loans generally capitalize when repayment begins, deferment or forbearance ends, upon default, when payment plans are changed, or loans are consolidated.  While private loans can offer delayed capitalization on unpaid interest in certain situations, you should check your loan terms to make sure.

  • Consolidation - does not lower interest rates but can be helpful to change older variable rate federal loans to fixed rates and to make it easier to make payments.  The interest rate is set by taking the weighted average of your underlying rates and rounding up to the nearest 1/8th percent.  Currently, they can also help make certain loan types previously ineligible for forgiveness eligible.  Know the pros and cons, as you cannot undo consolidation.  You do not have to consolidate all of your loans and can choose to do so only with some.  Consolidating Perkins loans will make you lose some of the unique benefits such as loss of subsidized interest free periods, and loss of forgiveness program options specific to Perkins loans.  Traditionally, consolidating has also reset the clock for PSLF qualifying payments, though that is not currently the case at the time of this writing (please check).  

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