PRIVATE PRACTICE JOURNEY

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.

1. 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...

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
1. Major expenses: lease, equipment, payroll, software/technology, vendors
2. ...