Starting a medical practice puts all of this on your plate.

Your practice start-up guide, section by section.

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Free practice start-up checklist

Use the free practice start-up checklist to organize key tasks and plan their sequence. Adapt the timeline to your practice and confirm requirements with the relevant agencies and payers. Request a copy through PPS.

Business planning & strategy

A business plan connects your goals with the decisions needed to reach them. Take time to define the practice you want to build, the patients you hope to serve, and how you will fund and measure progress. The steps and resources below can help you begin.

• Identify your preferred area and compare locations, patient demand, access, and occupancy costs.
• Decide on a name and discuss the permitted entity structure with your attorney and accountant. State professional-practice rules and tax treatment both matter. An S corporation election using Form 2553 is an option for eligible entities, not a requirement for every practice. See the IRS overview of business structures.
• If your public-facing practice name differs from your entity name, confirm any DBA registration and professional naming requirements.
• Prepare a budget with your accountant, including opening expenses and the cash needed while revenue builds. See the SBA business planning resources.
• Develop best-case, expected, and conservative financial scenarios. Use the Medicare fee schedule lookup as one input where appropriate, then account for your actual payer mix and expected collections.

Our Articles:

A customizable pro forma template

If you have discussed a business plan or financing, you have probably been asked for a pro forma. This financial model helps you organize assumptions about revenue, expenses, and cash flow. Our customizable template gives you a starting point to review with your accountant.

A pro forma is useful even when you are not seeking financing. It lets you compare scenarios and see how patient volume, reimbursement, staffing, and other decisions could affect profitability. The projections depend on your assumptions, so update the model as you learn more about your practice.

The PPS template includes three financial statements:

• Income statement, balance sheet, and cash flow statement. Use the three views together to understand profitability, assets and liabilities, and available cash.
• The template is designed for use in Excel. Review the assumptions and formulas with an experienced healthcare accountant so the model reflects your practice, rather than relying on a template without adapting it.
• Here is a helpful overview of a pro forma: Pro Forma Financial Statements

Contact us if you do not have an experienced healthcare CPA and would like us to connect you to the firm we recommend.

Start-up credentialing & contracting

Credentialing and contracting can be challenging for a new practice. Our team helps organize applications, follow-up, and payer requirements so you can track the work alongside your opening plan. If you prefer to manage some of it yourself, the resources below provide a starting point.

How early should credentialing begin?

Begin planning several months before opening. Timing varies by payer, network availability, application completeness, and the practice structure. Existing participation under another group does not automatically transfer to your new practice. Confirm which applications, group affiliations, and contracts each payer requires, and track effective dates separately from submission dates.

What affects credentialing costs?

The scope depends on your number of providers, locations, payers, and the work already completed. Ask for an itemized quote that identifies applications, follow-up, contracting, and ongoing maintenance. When comparing vendors, confirm who handles sensitive information, how it is protected, and who is responsible for each task.

How does insurance contracting fit?

Credentialing, contracting, and enrollment are connected, but their sequence varies by payer. Aetna, for example, describes contracting before credentialing for some applicants in its network joining process. Review the agreement, reimbursement terms, and effective date before assuming you are ready to bill in network. PPS can help evaluate the terms and develop a negotiation approach. Once the practice has operating data, revisit opportunities based on your performance and the contract terms. Learn more about payer contract negotiations.

Credentialing resources

Website & marketing

Your website is often a patient’s first impression of your practice. It should explain your services, introduce your team, and make the next step easy to find. For a new practice, a clear website also helps distinguish your approach and answer questions before the first visit.

Digital marketing can help you reach people looking for your services. The right mix of search, local profiles, social media, and paid advertising depends on your market and goals. Plan a budget, track inquiries and appointment requests, and review what produces useful results before increasing spending.

What should a website and marketing plan include?

• Useful, intuitive features. Design around your patients. Make directions, insurance information, new-patient instructions, contact options, scheduling, and the patient portal easy to find. Add features that support a clear task without making the site harder to navigate.
• Search-friendly content and structure. Help visitors and search engines understand the services you provide and where you provide them. Review mobile usability, page speed, clear headings, and working links. Evaluate a website on its implementation and content, rather than assuming a template alone determines search performance.
• Appropriate social channels. Maintain accurate profiles on the channels your patients use. Introductions and procedure explainers can help people understand your practice. Set a realistic publishing plan and measure whether the content helps visitors take a useful next step.
• A marketing plan and budget. Define your audience, priorities, and how you will measure inquiries and appointment requests. Allocate a budget appropriate to your specialty and market, then review results regularly. There is no single monthly amount or return that applies to every new practice.

View Our Medical Website Design page

EHR & billing services

Selecting an EHR and billing platform is one of the most important decisions you will make as a start-up. Compare how each option supports your specialty, clinical workflow, and revenue cycle. PPS draws on experience with a range of EHRs and billing companies to help you evaluate the fit.

Discuss implementation, training, interfaces, support, and the total cost before signing. Confirm any preferred pricing or package offers in your written proposal. A good demonstration should show the work your staff will actually perform, not just a list of features.

Keys to Selecting the Best EHR & Billing Service for Your Practice:

• Hosting, security, backup, and downtime arrangements that fit your practice
• Interfaces with your laboratories, pharmacies, and other partners, including setup costs and timing
• Clearinghouse tools and claim-editing rules to identify errors before submission
• Eligibility verification and patient cost-estimate tools, with a clear explanation of their limits
• A patient portal that connects clearly with your website
• Online payment options and understandable transaction fees
• Standard and customizable reports for clinical, billing, and business needs
• Templates that fit your specialty and can be adapted to your workflow
• Secure information-sharing with referring and collaborating clinicians
• An implementation and training plan for you and your staff
• Patient appointment reminders and communication preferences
• Usability demonstrated through realistic tasks with your team
• Support hours, response expectations, and included services documented in the agreement
• Tools that support efficient patient care and day-to-day practice management

Medical & office supplies

Buy the equipment and supplies needed to provide safe care, while protecting cash for the rest of the launch. Start with your expected services and patient volume, then plan replenishment. A purchasing budget helps separate essentials from items that can wait.

Plan stock levels and lead times. Confirm delivery times with your suppliers, including a backup for essential items. Keep enough stock to support scheduled care and reasonable contingencies. Do not assume every item can be delivered in a few days.

Consider the opportunity cost. Money committed to excess inventory is not available for staffing, rent, marketing, or other priorities. Compare purchases against the whole launch budget.

Before buying, consider whether an item is needed at opening or can be added as demand grows. Savings can support other work, but spending on marketing does not guarantee a specific number of patients or amount of revenue.

When evaluating business development, consider the value of the first visit, ongoing patient relationships, and appropriate referrals. Use realistic assumptions in your financial plan.

Compare at least three quotes for major purchases where practical. Used equipment may be appropriate if its condition, maintenance, warranty, and suitability meet your needs. Ask PPS about purchasing resources and any current group purchasing arrangements. Confirm participating vendors, membership terms, and actual quoted savings before including them in your budget.

Additional Resources:

• Physicians Practice: 10 ways to save money (2013)

Staffing & payroll

Hiring your first team is an important business decision. Define the roles, workload, and skills your practice needs before interviewing. Both overstaffing and understaffing can affect the launch. Our article on mistakes to avoid when starting a practice explores these decisions in more detail.

What We Recommend:

• Set clear policies. Use an employee handbook to explain expectations and procedures. PPS offers a customizable handbook, but it should be adapted to your practice and reviewed for applicable employment requirements.
• Evaluate payroll support. A payroll service can help with payroll processing and filings. Confirm which taxes, insurance tasks, and administrative responsibilities are included. Using a provider does not remove the employer’s responsibilities.
• Use a consistent hiring process. Ask job-related questions, check references, and follow applicable requirements for any background screening. Evaluate communication and reliability alongside technical skills.
• Structure skills assessments carefully. If an applicant performs work for the practice, address pay, supervision, confidentiality, and applicable employment requirements before the trial begins. Do not treat a working interview as free labor. See the Department of Labor guidance on hours worked.

Compliance: OSHA, HIPAA & Medicare

Make compliance part of the opening plan. Staff need role-appropriate training on patient information, security, infection prevention, workplace safety, and other requirements that apply to the practice. Assign responsibility for policies, training records, and follow-up.

PPS offers online compliance training support. Training is one part of a compliance program, alongside appropriate policies, safeguards, and ongoing review. HHS does not recognize private certifications as proof of compliance with the HIPAA Security Rule. See the HHS explanation of HIPAA certification.

Ask PPS for current training options and per-employee pricing, including any group rates.

How much does it cost to start a practice?

Start-up costs depend on your specialty, location, space, equipment, staffing, and operating model. Build a budget from current quotes, including the cash needed before collections cover expenses. Start with our lean start-up guide and practice start-up cost guide. The cost guide includes historical examples to adapt to your own plan.

Real estate and staffing are often major commitments. Compare options before signing a lease or building the team, and model how lower-than-expected patient volume would affect cash flow. Keep the opening budget connected to the monthly operating budget.

Understand how costs behave

Fixed costs stay relatively stable within a planning period, such as contracted rent. Variable costs, such as many consumables and transaction fees, change with activity. Staffing and utilities can have both fixed and variable elements. Separate one-time purchases from recurring expenses, and check the assumptions with your accountant.

A practice with substantial fixed commitments needs enough cash to cover them while patient volume builds. Test conservative scenarios before committing to expenses that are difficult to reduce.

Planning resource: SBA guidance on start-up costs and break-even planning.

Resources for your new practice

Explore the guides below or request a copy of a PPS resource. Some materials are supplied by email; paid resources are identified separately.

• Request the practice start-up checklists
• Customizable practice employee handbook (paid resource; ask PPS about current pricing)
• Medicare Enrollment Tutorials and Guidance
• Request: Medicare Wellness Forms
• Request the physician employment agreementHave an attorney adapt it to your arrangement and applicable law.
• Request: HIPAA and Mental Health Information Sharing
• Request the practice OSHA safety plan kit
• Request: OSHA Workplace Injury Form
• Request: HIPAA Sharing of Information Notice
• Request: Checklist for Sharps Injury Prevention
• Request: Notice of Privacy Practices
• Request: HIPAA Release Form
• Request: HIPAA Privacy Assessment Checklist
• Medicare Bank Letter Template

Client experiences

Excerpts from reviews retained on the original PPS website.