Practice Startup Checklist for Medical Practices [2026]

Plan for 9–12 months minimum from decision to first patient. The credentialing process alone takes 90–180 days for commercial insurers and 60–90 days for Medicare. Rushing the timeline almost always results in revenue gaps at launch. If you need to open sooner, begin credentialing and entity formation simultaneously on day one.

Most solo physicians choose a Professional Limited Liability Company (PLLC) or Professional Corporation (PC), depending on their state. PLLCs offer pass-through taxation and flexible management. PCs are required in states that don’t permit PLLCs for licensed professionals. Both protect personal assets from business debts, though neither protects against your own malpractice liability. Consult a healthcare attorney to determine which structure your state requires and which provides optimal tax treatment for your situation.

Total startup costs range from $70,000 for a lean telehealth-first solo practice to $500,000+ for a multi-physician specialty practice with equipment and full buildout. A typical solo primary care practice in leased space runs $100,000–$200,000. Major cost drivers are leasehold improvements ($20,000–$60,000), medical equipment ($10,000–$150,000), technology/EHR ($5,000–$25,000 first year), and operating reserves for the pre-profitability period (3–6 months of overhead). See the full breakdown in our practice startup cost guide.

Medicare enrollment for a new individual provider (CMS-855I) typically takes 60–90 days when submitted without errors via PECOS. Group enrollment (CMS-855B) can take slightly longer. Common delays include NPI data mismatches, missing supporting documentation, and contractor backlogs. Submit as early as possible — Medicare allows retroactive billing for up to 30 days prior to the effective enrollment date if approved.

You need a DEA registration only if you will prescribe, dispense, or administer controlled substances. If your practice will not handle controlled substances (e.g., certain psychiatry models using non-controlled medications, or practices that refer out), DEA registration is not required. DEA registration currently costs $888 for a 3-year term and requires an active state controlled substance permit in most states. Apply online at the DEA Diversion Control Division and budget 4–6 weeks for processing.

At minimum, you must have: (1) a written HIPAA Privacy and Security program including a Notice of Privacy Practices, designated Privacy Officer, completed Security Risk Analysis, and staff training documentation; (2) an OSHA Exposure Control Plan covering bloodborne pathogens if clinical services involve potential blood or body fluid exposure; and (3) a written compliance policy covering coding and billing practices. State law may require additional programs. Use our HIPAA Self-Assessment tool to evaluate your readiness.

Most new solo practices benefit from outsourcing medical billing during the first 1–2 years. Outsourced billing companies typically charge 4–8% of collections with no fixed overhead, which is often more cost-effective than a full-time biller ($40,000–$55,000/year salary + benefits) when your volume is still ramping. The trade-off is less direct control over follow-up and patient communication. If billing volume will exceed 250 claims per week within 6 months, building in-house capability from the start may be more economical long-term. See our guide: How to Choose a Medical Billing Company.

CAQH ProView is an industry-standard provider credentialing database used by most commercial insurance payers to verify credentials during enrollment. Creating and maintaining a current CAQH profile is effectively mandatory for any physician who wants to be in-network with commercial insurers. It centralizes your credentialing information so payers can pull verified data rather than requiring you to submit the same documents repeatedly. Registration is free at proview.caqh.org. You must authorize each payer to access your profile and re-attest quarterly to keep it current.