Small Private Practice - Random Questions

[Candidate2017]

I'm interested in starting a small private practice and hoping to see if there are answers to my random questions.

1. Telephone. What do you guys use? Google voice, google voice for business, another cell phone line, dedicated line, something else?

2. Get an NPI 2 or stick with my NPI 1? I work at another clinic, and will probably also do hospital work while getting PP started. I may or may not add other psychiatrists. If I do, maybe NPI 2 will be useful?

3. Credit card processing. Which processors do you prefer?

4. Checking in. I won't/can't afford a secretary at the start. Are there EMR or systems that allow patients to check themselves in? I've seen psychologists use QR codes that patients scan. Though, I'm not sure everyone is tech savvy enough to do that.

5. Sole proprietorship. I'm thinking starting off as a sole proprietor then switching to LLC/LLP. Will there be any forseeable difficulties with transferring assets like EMR, phone systems, business accounts, credit card processing agreement etc to the LLC?

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[clozareal]

1. Google Voice. You need to sign a BAA with them though to become HIPAA compliant.

2. NPI 1 while I'm a sole proprietor. Thinking about NPI 2 when I grow the practice.

3. Bluefin has integration with Luminello which is nice, but can be more expensive than the other options that aren't integrated. I looked at Ivypay, Elavon (you need a Costco membership), and Square which have lower rates but no integration. You might be able to negotiate rates between the credit card processing companies.

4. What do you mean by checking in? Like when they get to your office? You can just walk out but I've heard of people using a remote indoor light switch or an iPad set up in their waiting room with a sign in app that can do this, like MedicalCheckIn, etc. If you're referring to intake paperwork, some EHR's have this integration to enter in their information before the appointment. Zentake, IntakeQ, DigitalIntakes, PracticePal, and many other websites have this function.

5. Sole proprietorship. Not sure if there'll be problems switching to an LLC. I'm sure you can find a legal service that can help you with this. Some options include LegalZoom, RocketLawyer, Nolo.

 

[calvnandhobbs68]

For number 5, I don't think there should be difficulties with transferring things over to an LLC from sole proprietor. That's what I'm planning to do at some point, I just didn't want to bother with doing all the LLC stuff this year. Tax-wise, there's no difference between a sole prop and a single or you+spouse LLC, so it shouldn't matter much in terms of transferring assets either. You'll just have to individually get each business to change the contracts to doing business with your LLC rather than you personally.

If you own your own practice, for the agreements with patients, you may have to have them all sign new paperwork, especially in regards to charges/credit card agreements and policies. But yeah, would also recommend paying a lawyer to talk about that when you make the switch.

 

[clozareal]

Sole proprietors are not eligible for NPI 2. It'll become more relevant to apply for one once you become an LLC or incorporate. I find it weird that insurance companies will ask for an NPI 2 when you go to credential with them as a sole proprietor.

 

[TexasPhysician]

you never mentioned if you are going to be cash only or take insurance. You will likely need an NPI 2 if you take insurance. If you are cash only, it is irrelevant.

Depends. If you are cash only but may do side jobs with insurance, the cash job needs a NPI-2

 

[Candidate2017]

I'm leaning toward cash while applying for insurance paneling for 1-2 higher paying insurances. So I need an NPI 2? Also, I thought anyone (including sole proprietors) can get a NPI 2 if you consider yourself a group, not necessarily an incorporated or LLC entity.

The insurance websites say if credentialing as a group or NPI 2, you need a "Medicare approval letter". Anyone know what that is? I tried calling the insurance but was on hold for 20 minutes before they hung up.

 

[clozareal]

I believe you have to enroll your practice into PECOS and the medicare agency in your region will prepare the medicare approval letter as the last step of the process.