Open graph New Practice and credentialing | 4 Steps to Setting Up a New Practice and Credentialing | STATMedCare Payor and Physician Enrollment and Credentialing

Branching Out On Your Own

When branching out on your own, and considering setting up a new practice, there are many details you should be aware of.  In this post, we are only going to cover the basic details of setting up a new practice. For a complete guide, and help setting up your new practice, please consult with your local medical society and ask them for a referral to a Practice Consultant who can advise you on all applicable laws and things you should know before starting a new practice.

Step 1: Location

Choosing a location is often the first step in opening a new practice. Be sure to take into account:

  • any non-compete clause you may have that will prevent you from opening a practice within a certain proximity to your prior employer;
  • if you plan to round at the hospital(s) – be sure to open a location close enough to the hospital that you feel comfortable making daily trips there; and
  • that you cannot start the credentialing process until you have signed a lease and have mail coming to your new office.

Before leaving your prior employer, note that after you have a signed lease, it will take approximately 6 months to get you credentialed with insurance payors.  You cannot simply sign a lease and open your practice next month, unless you intend to only accept cash payments until you become in-network with insurance payors.

  Step 2: Timing

Opening a practice near the Holidays can be disastrous. When choosing an opening date consider, that less people attend doctor appointments during the holidays and summer vacation. It is best to start a practice in early Spring to maximize your reimbursement. Remember that if you open a practice in January most people will not have yet met their deductible and you will be collecting a lot of cash payments up front for any service not covered under the copay.

Step 3: Hiring Staff

Hiring staff is often the hardest thing to do. Knowing if someone will mesh well with your personality is often key.  Giving candidates a personality test such as the Myers-Briggs can help rule out any candidates that may not mesh well with your personality. Also, when you check references, do not call the references that the candidate has listed on their resume. Instead, Google each prior employer and call the number listed directly on Google. Often, people are very misleading on their resume. By calling the number listed on Google you can help ensure you are speaking to a real representative of the company who can confirm the candidate’s employment dates, wages and if they would consider hiring the candidate again.

Step 4: Licensing/Payors

Often a physician will overlook the fact that all licenses need to be moved to the new address. This means that before you may practice medicine at your new location you must:

  • have updated your Medical License, DEA License and Malpractice Insurance with the new location information.;
  • update your EMR so that when the claims are sent electronically to the insurance carriers your new address will appear (i.e. ensure that you have updated your practice address with the insurance payors first).
  • have changed all of your insurance contracts to show that you are now practicing at this new location.

If you do begin practicing before you have completed new location changes with the payors, all of your claims will be denied.


For more helpful tips and tools please:

Cynthia Young, the CEO of STAT, which is a U.S.-based, national provider of credentialing, payor enrollment, rate negotiation, and other credentialing related services.