Starting own NP practice

  1. I've recently been afforded an opportunity to start my own NP practice/business. I'm in Maryland and would love some info about starting one up and the legal stuff too. I'm obviously contacting the board of nursing and will be consulting with a lawyer, but just want some personal accounts and such. Thanks in advance.
  2. Visit MsMeliss83 profile page

    About MsMeliss83, BSN, MSN

    Joined: Apr '09; Posts: 16; Likes: 3
    from US


  3. by   Zyprexa
    Following! What type of practice would you be starting?
  4. by   Neuro Guy NP
    You're in an independent practice state so go for it! Check out bank of America, they have a program designed for providers looking to start their own practice! After I finish my neuroscience PhD I plan on working with them. I did some preliminary discussions with them and I think it checks out pretty well so I give my endorsement fwiw.

    I think consulting a lawyer or other business professional who is familiar with such matters is wise. Remember too that it may take 2 years to really turn a profit and get things off the ground with growing pains, etc. Take into account unexpected business expenses. I'm sorry I can't give you advice from the perspective of a practice owner but I do wish you luck.

    Go NPs!
  5. by   3ringnursing
    My current PCP is a NP who worked with my previous PCP (an MD) for 25 years until his death at 78 years old. She then took the bull by the horns and started her own practice. The MD that assists her is not on site - he is actually a couple of miles away in a separate office.

    We live in Tucson, AZ.

    I'd never seen that before, but I trust her with my life. I have SLE and a few other chronic health conditions.
  6. by   PANYNP
    I'm not sure whether it's permissible to endorse a book on this site, but here goes.

    Take a look at Carolyn Buppert's "Nurse Practitioner's Business Practice and Legal Guide".
  7. by   Neuro Guy NP
    Quote from PANYNP
    I'm not sure whether it's permissible to endorse a book on this site, but here goes.

    Take a look at Carolyn Buppert's "Nurse Practitioner's Business Practice and Legal Guide".
    Amen on this one! This is the best business book an NP could buy! I also recommend!
  8. by   lhflanurseNP
  9. by   pattifnp
    I called Bank of America because I saw their program for starting medical clinics. They mean MEDICAL clinics. Because I am an NP, they wouldn't even talk to me. I did get a loan, however, by contacting the Small Business Administration. $25,000 was approved with no collateral. My clinic is opening July 5, 2017!
  10. by   pattifnp
    I started the ground work for my clinic in October 2016, I'm am scheduled to open July 5, 2017.
    I used Legal Zoom to get started, it was a bit expensive but they got everything in order for me to get my EIN and registered agent, from there, I was able to get the state documents together and have done the rest on my own.
    Get your financing EARLY! I just got my loan a week ago, would have been easier if I had it sooner.
    You need to firm up your office address and phone number as soon as possible because it is needed for a lot of the paperwork and for credentialing.
    I just signed with the EHR and they are going to do credentialing for me.
    I'm on my way home from work now... I'll try to log on later and I'll give you more information about what I learned through this process. You can do it, just keep making a list of all your questions and things you anticipate needing.
    Good luck!!
  11. by   MsMeliss83
    Thanks for all the helpful advice! Im interested to know about people's experiences with EMR/EHR in the private practice arena. I will be my only employee, and most of my patients will be Medicare. So cost is important consider the low reimbursement.
  12. by   pattifnp
    I interviewed a few EHR vendors... I'm using PrognoCIS, they have been extremely helpful with credentialing, set up, and cost. I gave them my information and they ran with it.

    I have learned a few things I will share with you. No point in reinventing the wheel.

    Please read your local law/state statutes etc. But this is my experience.
    1. You need Employer ID. I did this with legalzoom, cost around $450 but they did the ground work and sent me in the right direction. You might look on line for info how to do this yourself. With this you establish your clinic as PLLC - professional limited liability company - ask your attorney or accountant which is the best way to handle your tax structure.
    2. You need a registered agent. Legalzoom did this for me too, was included with the above fee. The way I understand this, the registered agent keeps track of where you are so that if there is any legal information that needs to get to you, they will find you.
    3. Credentialing:
    a. Practice NPI - this takes 2 minutes on line, you need your office address, phone number etc
    b. Malpractice - this was more difficult than I thought because you will need a collaborating physician even if you are in a state that doesn't require it. (truthfully I didn't look into this very much because I'm in a state that does require collaborating physician) You don't want to pay your CP's malpractice, so if you have a CP, you need his/her Certificate of insurance. I used for my malpractice, they were very helpful and included liability.
    c. EIN (employer ID or tax ID) this is from the feds - as I said above I got it from LegalZoom
    d. My state board of nursing had to write a letter to verify that I am a registered nurse and legally able to provide nursing services
    e. Articles of organization: this came from the secretary of state in my state - LegalZoom helped get this in place too. (Their fee was really reasonable since they laid the path for me.
    f. personal NPI
    g. CAQH ID and password
    h. Medicaid ID and password if your state has it on line

    4. Loan: You need to write a business plan. This is a MUST. When you do your business plan, you will think of a ton of things you need, want and this will not only keep you organized it will help you with your financing.
    The bank will want your EIN, articles of organization and probably a letter from your state board of nursing. You may have to have your collaborating physician sign on the loan, not as an owner, but just that he/she is in fact, your collaborating physician. This bothered me a little, but I didn't have trouble getting a signature. Your loan expectations should be realistic. Look for office space, think about utilities, supplies, rent, EHR (around $600/month should get you started) Remember that you probably won't be paid by insurance for a few months, so give yourself plenty of time. You can go to the Small Business Association - look on line and you will find that you can get $25,000 without collateral, banks will contact you when you sign up. I applied at a local bank tried to get $50,000 for start up to pay expenses but they wanted me to put my house up as collateral... it was too scary, so I used recommended lender from SBA and got $25,000 within a couple of weeks.

    5. Business bank account - Open an account as soon as you can put money into it. Usually need $100 to open the account, but you'll be glad you did. When you pay for things like EHR and for Medicare credentialing, you bank account NAME (name on your checks) must exactly match the EIN so than Medicare will pay you.

    6. The EHRs I interviewed - you can find them on line - everyone has their own ideas about how they like their data managed. PrognoCIS, Athena, MediTouch, DrCHrono are the ones I worked with. I ended up with PrognoCIS because they took care of a lot of details for me.

    7. Building, utilities: I just signed my lease last weekend. I have the keys!!! The building is empty, need chairs, tables ... exam tables are expensive, but there are some deals on eBay, and look on line for some medical discount places. I'm starting with the bare bones. When you sign up for phone, elect etc. you will need your EIN number here, too.
    8. Your bank can help you with credit cards. My bank also has some HR services available, they will write paychecks, have insurance services etc.. it's a bit pricey .. but you can look for services you want to provide to your staff.
    9. HR - you need CMS compliance forms - I just learned about this today from the malpractice guy, he is going to send me the paperwork for that. Also need worker's comp insurance and the signage to be in compliance with labor laws. This is on line too.

    Make a list of everything you need. It's like playing chess. Moving one piece forward while you wait on others... then you proceed with the next layer...

    I made a note book - keeping original documents in there, plus I scanned them into files in my computer. Just keep checking off your list. There's a lit of pieces but you can do it if you keep organized! I am working full time,, just finished my DNP (full time program) and have been setting up this clinic in my spare time...

    GO NURSES!! FREE the NPs!! I wish the collaborating practice obstacle would go away from credentialing, financing and malpractice. (I think I forgot to mention.. Insurance companies will not pay you unless you have a collaborating physician, even if you live a state that doesn't require it) UGH!

    FREE the NPs!!
    Best of luck!
  13. by   BrittWil
    Hi! Great post! Did you look into other malpractice companies and did they all require a CP? That doesn't make any sense if the state of Maryland doesn't require it....that is so frustrating!
  14. by   Cool Nurse, BSN, RN
    Hi, thanks for the great post. It's been almost a year since you posted this, if you could please give us an update on how your business is doing, that would be awesome.