Practice Startup  in Missouri
                                             key tips

update 1.8.02 list of issues   key points     contact info  
                      PO Box
cost is about $ 60 per 6 months
be sure to use a PO substation close to your office
   
                      Change of Address
make a form letter then send to all
takes 3 months for most changes to get finalized
 
AMA,  old office,
hospitals,  licensing, DEA,  BNDD, 
magazines, professional societies,  Postmaster
all common insurance co along with your W-9
 
                      Lease
 
Try for $1,000-$1,500 per month  per doc  
                      Bank 50K loan
use the same bank for your family account
  the loan takes 1-2 days to approve a promissory note at prime
When you need startup money, just call the bank
  and draw from your limit. 
No significant cash flow for 60 days,
  so live on your savings and the promissory note
 
                      EIN
you will need your Federal Employer's Identification Number (SS-4) prior to filling out most other forms; take minutes to get if you call or fax:
Phone:  866-816-2065   or  
               800-TAX-FORM
FAX:     215-516-3990
www.irs.gov/forms_pubs/forms.html
 
                      W-9
Send to all insurance companies to inform of new EIN#
Phone:  800-829-3676
www.irs.gov/forms_pubs/forms.html
 
                      State Tax ID #
Local offices are located in most major cities
Check phone book for local listings for Mo. Dept. of Revenue, Business Tax Office; request Form 2643  
                      State Unemployment ID A simple form to send in  
                      Clia A simple form to send in & requires renewal q1-3 years  
                      Medicare A long & tedious form  
                      Medicare Railroad About the same as the regular Medicare form, but
   you must get it from them and mail to them in Atlanta
 
                      Medicaid A long & tedious form
  you should sign up if you share call or have any MC/MD
you can always control your new patient status
 
                      Cell Phone Far better than a pager
works in elevators & digital phones safe around
   high tech equipment
DON'T PUT YOUR NUMBER ON YOUR BUSINESS CARD
use your outgoing message to note who is covering & if you
  are out or will call back soon--
   have a backup battery readily available
 
                      Answering Service
it's the way we doctors have done things for 30 years
but the cell phone is quicker, cheaper,
and only gives the wrong info if you forget to upgrade your
    message on the voice mail
The answering service works well for the hospital & group staff, but the service typically has a hold time when the pt calls and occasionally isn't clear on who is on or out.
If you use only a cell phone your office phone needs a reliable outgoing message when you are closed
 
                      Business Cards Primarily your name, address, & phone
fax strongly recommended
office website if you have one
consider your e-mail, picture, or cell/ans service-
   but generally  these latter issues cause problems
you don't want to change business card # very often
 
                      Staff Run a newspaper ad & require applicants to
  complete your own application with key data
   you need
have a list of benefits besides pay check
 
                      Provider Network The form is standardized by the state & is long
complete one then file it and copy as needed
each network wants all the same info from the doc
 
                      Office Forms Use your word processor and make your own
   you'll  save a lot on monthly expenses
several generic versions we made & used in 2001 attached-
    -- feel free to use and adapt as you wish
--
           all from Word97 and generic format (RTF)
 
                      Office Checks 1 or 3 per page & the cheaper the better
expect your software to write the checks--eg Quicken
 
                      Office Brochure It's easy--
  just a front and back of normal sized paper for a tri-fold
  and a front and back of legal paper for a quad-fold
after you add the verbiage a printer can make
  --generally 80 lb paper, glossy, 2 color ink
about $200 for 2,000 brochures
 
                      Office Supplies Your local discount store first then
  a medical paper supply like Colwell
 
                      Office Computer At least
   P3 550 chip-- so you can manage numbers & voice-type
   96 ram &  40G  hard drive
   CD burner (CD-R) so you can do backups
   floppy drive to add your dictation that might return
   56K modem so you can link to the WWW & get e-mail
   network card on each computer
(eg. any new $900 system has all this and more)
 
                      Computer Network 10/100 speed and at least 4 ports 
      $20-40 for the switch box
some network cable (looks like phone cord but 8 wires inside) 
        cost is about $15 for 25 feet
then just plug and play; Windows98 and up make all this
   very easy to start and only takes seconds
eg.  Best Buy staff can tell you how to do it when they sell you the equipment
 
                      Key Office Equipment Fax--Hot Fax 5.0 ($50) for incoming faxes is a real saver
             on ink & paper, but you still need a machine to send
               paper from chart
copy machine-- need at least 8 pages per minute
     and top loader for multi-pages when copying records
     the new HP laser copiers are $400 for fantastic machines
     the cost of use is about 1/2 cent per page
     digital is superior to analog for cost and quality
 
                      Office Phones At least 2 incoming lines & prefer 3 with the same #
need  hold, forward, mute, an answering machine
and an outgoing message when office is closed
linking to a hospital PBX system is quickest & initially
   cheapest solution
at least 1 line must be analog for fax
      and possible wireless phone
 
                      Software Accounting--checks & payroll-- try Quicken or QuickBooks
patient billing & producing HCFA claim forms--
   ask local docs,
  generally they have a yearly renewal fee
  several like Medware are $600 to get started
   and work great
use MS Office for word processing & database mgmt.
 
                      Payroll System You can do it on your own if you have the forms & understand book keeping
QuickPay is easier but does have about $100 yearly renewal
 
                       Lab Patients don't want to go to the hospital for routine lab--
   DRAW IT IN YOUR OFFICE, then let a referral lab like
    QUEST stop by late pm and pick it up.  Quest can bill
     almost any insurance company & must bill the Medicare
    and the Medicaid, but you can bill the commercial
    accounts. Contact them via the # in the Yellow Pages.
 
                      Office Web Site Easy with FrontPage see this article on how to do this  
                      Group Health Insurance Nearly impossible for the small office
generally better to have your own personal and portable policy and same for your staff, but offer a $ amount of monthly help that you can deduct via a cafeteria plan
 
                       Collection Activity Your registration sheet needs to note late charges.
You can require pre-payment for future office services of
   those turned  w/o the extra effort of formal dismissal.
 
                      OSHA Mainly a written needle stick protocol
& yearly update on B&B precautions
and the Hep B vaccine for staff doing needle work
 
                      MSD A simple notebook to file & forget
  the Managed care systems will inspect
   and want to see one sitting on the shelf
    --another link for this info--