Happy belated New Year!

Sorry, I haven't posted much. But as you've probably guessed much has changed! For my readers that are concerned, I will never post wholesale costs.  Our tenants officially vacated our property in December, so we were able to get moving with the build out of our office. We are permitting with the City this week and should have an open private practice (*fingers crossed*) by May 1st!!

General Rule: Always add a few weeks extra when general contractors tell you when you're buildout will be complete.

I've been practicing at a private practice $400 a day, for the last 3 months. Although he offered me a full time position, I declined. I've learned quite a few things from the seniordoc. He has an impeccable reputation with patients, and a devotedly loyal staff (unlike my previous employer), and his office grosses around $1.1 million on 4 days a week! I'll have to post more on his management techniques and what he does different.

Along with this, I took a one year lease at Wal-Mart, 2 days a week to "prep" me. I plan on testing out my exam forms, systems, patient flow and figure out how to verify/bill medical insurance before the private practice is open. I've been averaging about $400 day net profit there also.

So far I've:

1. Hired two employees. Lesson Learned: How to handle W-4's and do payroll www.paycycle.com
2. Averaged ~10 patients a day (in 3 months). Lesson Learned: How to manage a front desk, schedule appointments, learn what patients commonly ask, learn how patients treat the front desk, maximize appointments. I will make sure in my private practice that when every patient checks out that we ask "Does anyone else in the family need an appointment?" and I always ask patients to refer friends and family to me at the end of an exam: it works!!!
   
3. Become a medical provider (BC/BS). Lesson Learned: How to verify and file insurance. I use Availity.com to verify a patients insurance benefits, and to submit claims. The system is confusing and redundant, so I got on the phone and had Availity walk me through it.

You know what makes me sick though? My exam fees are $79, and the private practice doctors around me charge LESS!!!!  

I will post more on this!

Must read tax planning advice

http://www.wickenslaw.com/Format_2005/Dental_Practice/Dental_%20Law.htm

It's geared towards dentists but this is a definite MUST read!!

How to credential with insurances.. the easy way.

CAQH is a consortium of health associations that aim to streamline the credentialing process. Here's how it works. Providers (you) fill out one application online, and submit them to as many insurance panels as needed.

The tricky part? You have to first be given a CAQH ID, by an insurance company. I chose Humana, and was able to get a CAQH ID in 2 days. Look around, I believe Blue Cross also provides these ID's in a short amount of time. Once you've recieved a CAQH ID, you'll be able to log on and fill out everything about yourself, where you practice, etc.

You'll have to fax all of your supporting documents (DEA, Malpractice, etc) for them to review it. Presto! You're done.

Filling out Medicare's application

If anyone has done this in the past, you already know how tedious this process is. I'll try to simplify the process and go through each section that you need to fill.

Firstly, if you are a sole owner of a company (PLLC, LLC, PA, PC) then you will only need to fill out the 855R form.

Section 1A: Check the box that says you are a new enrollee in Medicare.
Section 1B: Check the box that says identifying information, and practice location
Section 2A: Fairly simple, fill out your personal information.
Section 2B: I used my home mailing address for correspondence. You can use your practice address also.
Section 2D: I selected Optometrist. Write Primary beside it.
Section 4A: Use the business name and its Type 2 (Group NPI). Where it says Medicare ID number, write pending.
Section 4B: Write the business name, pending where it says Medicare ID number, and use the Type 2 (Group NPI).
Section 4C: Fairly simple here. In the NPI box, use your Type 1 (Individual NPI). Write pending where it says Medicare ID number.
Section 4E: If you want your payments sent to your house, or your practice select the appropriate check box.
Section 4F: Not necessary
Section 8: If you are not using a billing agency (likely NOT, if you are a startup). Check the box that says it does not apply.
Section 15: SIGN and done!

VOILA!!

Ordering office and clinic supplies

Over the past few months, I've created list of where to buy RX pads, light bulbs, cautery kits, sundry jars, recall cards, etc.

1. OOGP
2. Wilson Ophthalmic/Hilco
3. Moore Medical
4. Medical Arts Press
5. Bernell
6. E-Sharper.com
7. Sigma Pharmaceuticals
8. Brown & Bigelow (corporate identity)
9. Amcon Labs 
10. Eye Supply USA
    

Feel free to suggest more.

Updating DEA number

https://www.deadiversion.usdoj.gov/webforms/jsp/regapps/common/updateLogin.jsp

If you've changed locations there are several other things that you must do to stay current. Change your DEA number, and update your address with your State's controlled substances department.

Practice incorporated!

Today, I officially incorporated our practice online. Each state has their own procedure on how to form a company. Cost $300. When a company is formed, you get what's called a Certificate of Formation. Hang onto this, because it serves as a "birth certificate" of your company.

I advise all optometrists (and other professionals) to form a PLLC. My corporate name is "[Last Name] Family Eye Care, PLLC." I will likely take the S-corp election when I file my taxes. BUT, remember to consult your CPA and attorney regarding tax implications and record keeping rules. In some cases it is advantageous to start off as a sole proprietor, but a pain-in-the-ass to switch to a corporation down the road when you are established. I don't want to go into explicit detail of piercing the corporate veil, etc.. but Google should also help.

This is a good primer on the differences between companies: http://www.themoneyalert.com/Corp-Entity-Table.html

Next, I am applying for an EIN. Think of this as a social security number for your business. It's how the IRS keeps track of you. Luckily, you can apply for this online:
http://www.irs.gov/businesses/small/article/0,,id=102767,00.html

Once you've got the above two steps complete, you're good to go! Congratulations, you have completed the first step to the American dream... you own your own business.

Medicare numbers

I am currently registered with Medicare as a provider, however, since leaving the last practice.. there are rules with how this transfers. Call Provider Enrollment to verify.

You get what's called a PTAN number (individual, and group) anytime you are employed at a practice. These numbers are no longer valid when you: start a different job, start your own office, etc... think of them as one time use numbers that never carry over.

Applying the second time around is easier, according to Medicare, since you're already in their system. What form to use depends on your situation:

• If you are going to be employed again, you just need to fill out Form 855R
• If you are going to start your own practice (where you are 100% owner), fill out form 855I
• If you are starting your own practice with a partner (50, 50 owners), fill out form 855B. Make sure to also apply for a Group NPI number

Since I'll be doing both. Working and starting my own practice I will have to fill out form 855R and 855B with my wife.

Blessing in disguise

It seems like every time I post, there's a new development. This one is big:

My boss terminated my employment contract (to be quite frank.. she was a terrible boss, and not a nice person; perhaps you gleaned that from previous posts) last week, I don't want to get into details, oh well. Luckily we have something to fall back on!!

At this point, we are amidst a relocation (200 miles away). We'll now be living within 25 minutes from our practice. HELL YEAH!!

I did receive another $5000.00 rent check from my tenants for the month of October. I also called up my contractor now that things have been kicked into high gear, and was told I could have my practice ready in 90 days. Tick-tock!

Hardware costs

Little did I know, or figure into expenses that hardware would become expensive, some of these items are overkill and not necessary for a startup:

1. TalkSwitch Phone System. This is a biggie!! If your patient calls, and say line 1 is busy.. it will roll over to line 2, etc. A phone system does this for you automatically. When you call your cable company for your startup, ask for 3 dialtones (one fax, two phone lines).
   
2. HP LaserJet P2035N printer (my favorite is the Xerox Phaser 3300 MFP, too expensive for a startup)
   
3. ScanShell 800N card scanner
4. Acroprint timeQplus V2 biometric. Employee time clock, overkill at the start.. you can do manual payroll instead.
5. If you are in optometry school, or working for someone else at this stage... I urge you to learn basic bookkeeping/accounting, and familiarize yourself with Quickbooks.