My office is so old that I'm kind of useless here, but I'll throw what I can.
1. For the purposes of money you likely need a business plan to get a loan. If you are a resident and reading this and thinking about someday having a practice you should explore this - you can find free business plans online.
2. You need malpractice and you need to make a decision how much you want and the malpractice/liability climate of your state. You can actually do $600k/$200K malpractice, but certain insurances and hospitals will spell out what they expect. I bring that up because I always hear $3/1 million on here, but lower values exist. Claims made vs occurrence.
3. Presumably you'll accept Medicare. Your Medicare PTAN is one of those numbers you don't want to lose / always will have in a file. You technically can set your Medicare IA portal up so others can communicate/speak to Medicare on your behalf but Medicare always acts clueless when we try to do this.
4. Jokingly, every monitor around your office needs a sticky note with your (a) Tax ID (b) Practice NPI (c) and individual doctor NPIs on it because you are going to be constantly providing these to people for referrals, to speak to insurance etc.
5. You'll need a business checking account in your town. It will probably be where you take some of your loans
6. You'll likely need payroll / check writing software and probably some sort of business credit card.
7. Know that Medicare DME is separate from the Medicare process. There's a specific type of beneficiary called Medicare Railroad run through Palmetto and they are a separate process that isn't through normal Medicare.
8. Medicare DME requires someone coming out to your office to check-out your set-up.
9. You need to decide what insurances you are going to accept. There are insurances that will make it miserable for you to drop ie. United tries to make people sign 3 year contracts. You'll have to decide whether you'll take HMOs, Tricare, VA, Medicaid, Medicare Advantage plans, dual completes etc.
10. Some insurances require you to operate at specific hospitals or to be part of specific organizations, ACOs, etc. ACOs sometimes require specific EHRs because they want your data for quality reporting.
11. Insurance companies LOVE LOVE LOVE to offer you a fee schedule, never pay you at the correct rate, and then play dumb when you contact them a year later trying to get your actual loaded fee schedule sorted out. I've had this happen so many times that its clearly an industry regular form of fraud.
12. You need to decide whether you'll start small or have something to grow into. Do you want a larger procedure room where you could have space for fluoro. Do you hope to expand to more people ie. a slave/associate/certified $80K nail cutting nurse.
13. If you are in a free standing building that you own you'll have to maintain the parking lot, plow snow, keep people from falling on ice. If you have landscaping you'll have to maintain it. Some jurisdictions in the US are expanding the requirement for xeriscaping. No grass. Rocks. Desert plants that don't require water. You may need a garage or shed or closet for snow shovels, equipment etc.
14. Your office will need maintenance ie. lights will burn out, toilets will break. You can hire contractors and electricians. There will be handicap requirements. Apparently back in the day my office had a water fountain in the front area. It wasn't ADA compliant and it was cheaper to tear it out. Consider where your bathroom will be ie. will people have to walk through your office to get to it.
15. Phones. Email. Yes, we still use fax machines. If your fax machine just prints then you'll come in every morning with it covered in junk, spam, and enormous garbage referral notes. Consider having your fax machine set to create a PDF email that is sitting in your mailbox.
16. CAQH. You have to maintain it
17. Insurance portals. They are a huge pain in the butt, but a lot of the companies want you to use them. There are so many insurance companies and the same company can have plural portals.
18. You need your own availity login. There is nothing stupider than losing Availity for BCBS because your office manager left and now you are locked out. Same for DME - you need to be the person who owns the account login and the other accounts come from your account - not vice versa.
19. You cannot commit to a crappy overpriced EHR like Athena that won't pursue claims and costs too much. Gotta be lean.
20. You'll need insurance for if people fall down on your property. Consider that everything comes with consequences. My partner owns our office building. He owns beautiful trees that surround it. The trees damaged the concrete walkway surrounding the office and the liability insurance told him he needed to repair the concrete or someone would trip and he'd get sued. Then he wondered if he needed to cut the trees down. We didn't but having the concrete redone cost money.
21. You need to understand safe harbor if you do a 401k.
22. If you want to have a server and firewall and what now you'll need IT. They will want to charge you something ridiculous like$100/computer a month for IT/security/protection etc. Your computers will break. You'll have to decide whether you want to be your own IT person or hire someone. Will you give staffs laptops to walk around with or have computers in every room. Your x-ray company may try to charge you per computer and limit your x-ray licenses so you pay more to show x-rays around your office.
23. You need to find a reliable way to communicate information ie. will you communicate through your website, through facebook business, etc.
24. You'll have to decide whether you'll clean your own office ie. have your MAs do it, you do it, or whether you'll hire someone. There will be regional variations in price. If your MAs worked at another doctor's office that was richer than you - ie. everyone else - they will hate cleaning.
25. You'll need an x-ray machine. You'll likely want to have some sort of mechanism to back it up. To the cloud? Or on site.
26. If you do paper charts you'll need space to store them and you may need to pay to store them offsite somewhere.
27. Quality reporting for MIPS/MACRA bullcrap.
28. If you are selling things ie. orthotics - you'll need space for them. You'll need to store and organize your DME. You'll need space for your injectables. You'll need inventory lists so that your staff can take inventory. You need space for stupid stuff like paper towels and toilet paper, mops, and brooms, and vacuums.
29. Autoclave.
30. If you own your building it may have property taxes.
31. Stupid crap can happen - roofs leak in a room where you store a shockwave machine.
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