Private Practice start up questions (legal, EMR, Billing)

[milesed]

I have been an employee as a board-certified Child/Adol and general psychiatrist for 20 years at my current job and will need to start a practice (in a year if things at current job don't change by then) or will stay and retire in 8 years and start a practice then. I am the only C/A in the area and the 3 private general psychiatrists are all retiring soon. There are no psyc ARNP's in area.

I'd be in solo practice with 1-2 receptionists, renting space and setting all details up on my own. I'd like do med management mostly for patients 18 and under. I'd likely farm out billing initially.

What type of legal entity do you recommend- LLC S, PC, etc. and why?
Which EMR do you use and what are costs I should expect at start up and yearly? I'd like web-based scheduling, eRx and documentation at least.
If you pay a vendor for billing, which did you choose?
What were the unexpected costs or other negatives you ran into?

Thanks in advance for any input.

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[wolfvgang22]

I think if it's just you an LLC or PC would be overkill. I don't see what advantage a LLC or PC would provide if you have no partners or clinical employees other than one receptionist. Sole proprietor would probably be fine. I don't have any experience in private practice, though and I'm also interested to learn more.

 

[dl2dp2]

LLC is easy to register, which I would recommend, since this protects against business liability (i.e. backed rent, slip and fall, etc.) Of note it does not explicitly protect against medmal.

People always confuse business entity vs tax treatment. LLCs can be treated as a sole proprietor, S-corp OR C-corp, depending on how you file taxes. If you get an LLC and file as a C-corp, you'd file a corporate tax form in addition to personal tax. There are significant tax advantages at high income for C-corp (vs. S-corp) due to Trump corp tax cut, but this obviously may reverse.


For your purposes, I would just go simple straightforward LLC taxed as sole proprietor. The main reason for S-corp is to pay less FICA, as by definition owners must have a payroll in S-corp. There are other advantages of S-corp, where you can convert short term distributions into long term distributions.

PracticeFusion is decent $100 per month. There are a few others that are fairly comparable (Kareo, Athena, Epic). Top 10 EMR & EHR for Small Practices

Billing: are you sure you want to do this? Do the retiring MDs take insurance? One way to start your practice very quickly is to buy their practices. They can do an owners financing. You can hire a professional appraiser to estimate the value of their book of business especially since they are all insurance based. I'm sure the retiring MDs would love to have an additional cash flow when they retire.

 

[Sushirolls]

Read this thread:

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

On that thread is a 30+ step play by play of how to open your own practice towards the end.

Luminello is perfectly meant for C&A with how the chart is set up for parents and other family members.
Stay away from Athena, they will take a massive percent.

LLC as Sluox says. But talk it over with a lawyer first. Then talk to the accountant about actual tax structure.

 

[watto]

Read this thread:

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

On that thread is a 30+ step play by play of how to open your own practice towards the end.

Luminello is perfectly meant for C&A with how the chart is set up for parents and other family members.
Stay away from Athena, they will take a massive percent.

LLC as Sluox says. But talk it over with a lawyer first. Then talk to the accountant about actual tax structure.

Sushi, you should check with an admiinistrator to get that checklist stickied, either on its own or in the tips for private practice sticky. It shouldn't be buried in your thread.

 

[milesed]

Wow that linked thread is a wild ride and I'm only through page 1 so far.

Thanks for the suggestions so far. I will start looking into Luminello, other options. I was offered a practice purchase here years ago, but the psychiatrist really only had about 15 hr/week filled and used various contract jobs for the rest. I'd prefer to not buy anything from current psychiatrists as will be zero competition for me and feel I'd just be paying for a practice structure and contacts for lawyers, CPA's, etc.

 

[Sushirolls]

Wow that linked thread is a wild ride and I'm only through page 1 so far.

Thanks for the suggestions so far. I will start looking into Luminello, other options. I was offered a practice purchase here years ago, but the psychiatrist really only had about 15 hr/week filled and used various contract jobs for the rest. I'd prefer to not buy anything from current psychiatrists as will be zero competition for me and feel I'd just be paying for a practice structure and contacts for lawyers, CPA's, etc.

Any updates on your Private Practice dream?

 

[milesed]

Not yet. I'm waiting to see what happens with current employer and the retirement system we are using.

 

[psyguru]

I have a private forensic psychiatric expert witness practice and use an S-corp. I work from home. Occasionally will rent an office for an IME. I do my own billing (only send out half a dozen invoices/ retainer contracts a month). I do have a website coder and marketing contractor I use PRN but otherwise, no staff is needed.