> ## Documentation Index
> Fetch the complete documentation index at: https://www.practiceownersguide.com/llms.txt
> Use this file to discover all available pages before exploring further.
# The Owner's Task Repo
> The full inventory of what a practice owner must do — becoming an owner, choosing a revenue model, building the patient payment stack, and the recurring calendar.
The full inventory of what a practice owner must do: becoming an owner, choosing a revenue model, building the patient payment stack, and the recurring calendar. The [launch checklist](/reference/checklists) is the condensed version. Use this page as a pre-launch audit, an operating calendar, and a diagnostic ("what are we not doing?").
## Part 1: The universal layer
Applies to every model.
| Layer | Tasks |
| ------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **Structure** | Professional entity → tax election → EIN → Type 2 NPI → I\&A account → state registrations → DBA if branded → buy-sell if co-owned. [Guide](/guides/choose-your-entity) |
| **Money** | Operating/tax/savings accounts → [loan](/guides/get-a-practice-loan) with 6+ months working capital → CPA and bookkeeping cadence → [access controls](/start-here/03-setting-up-your-banking) |
| **Risk** | Malpractice (tail planned), general liability, property, cyber, workers' comp, EPLI, life/disability tied to loan guarantees |
| **People** | Employment agreements (covenants per current state law), handbook, payroll and benefits, OSHA training, credentialing files. [Guide](/guides/associates-vs-partners) |
| **Systems** | [EHR/PM](/guides/choose-your-ehr), HIPAA-compliant comms with BAAs, phones/scheduling, website with disclosures, [paper intake](/concepts/lockboxes) |
## Part 2: Choose your revenue model
```mermaid theme={null}
flowchart TD
M{Revenue model} --> A[Insurance-based
credentialing clock rules the launch]
M --> B[Cash-pay / DPC
no credentialing, new obligations]
M --> C[Telehealth-first
licensure math + prescribing limits]
M --> D[Hybrid
watch the seams]
A --> A1[Credential → contract → enroll
EFT/ERA → test → reconcile]
B --> B1[GFEs mandatory · Medicare
opt-out decision · DPC statute fit]
C --> C1[License per patient state ·
Ryan Haight limits · EPCS · BAAs]
D --> D1[No copay waivers · GFE consistency ·
segregate revenue streams]
```
### A. Insurance-based (the guide's default path)
[Credentialing](/guides/get-credentialed) → [EFT/ERA per payer](/guides/enroll-eft-era) → [test the full cycle](/concepts/claim-lifecycle) → [reconciliation habit](/concepts/reconciliation). Timeline set by the 90-to-180-day credentialing clock.
### B. Cash-pay / direct pay
No payer machinery, but three obligations cash-pay owners routinely miss:
* **Good Faith Estimates are mandatory.** The No Surprises Act requires written GFEs for uninsured and self-pay patients for scheduled services (45 C.F.R. § 149.610; [CMS](https://www.cms.gov/files/document/gfe-and-ppdr-requirements-slides.pdf)). Build it into scheduling, not billing.
* **Medicare doesn't vanish because you don't bill it.** Treating Medicare beneficiaries for cash generally requires formally opting out with compliant private contracts (42 U.S.C. § 1395a(b)). Decide your posture explicitly.
* **DPC and membership models** are exempt from insurance regulation in many states, but only if the agreement fits the state's DPC statute. Concierge hybrids that also bill insurance need duplicate-billing review. Publish transparent pricing.
Everything in Part 1 still applies. Cash-pay is a billing model, not a compliance exemption.
### C. Telehealth-first
* **Licensure where the patient sits.** A license or compact privilege (IMLC, PSYPACT, NLC) in every state you serve. Your licensure map is your market map.
* **Prescribing limits.** Ryan Haight requires an in-person exam before controlled-substance prescribing, subject to DEA flexibilities [currently extended through 2026](https://www.mcdermottlaw.com/insights/dea-telemedicine-flexibilities-for-controlled-substances-2026/), with state rules layered on ([overview](https://telehealth.org/news/telehealth-prescribing-laws-in-2026-navigating-controlled-substance-rules/)). A model that depends on controlled substances is concentrated regulatory risk.
* **State variation:** modality and consent rules, payment parity, Medicare's shifting telehealth rules. Assign an owner to track them.
* **Platform:** HIPAA-compliant video with a BAA, identity verification, EPCS for controlled substances, an emergency plan per patient state.
* **Multi-state means multi-everything:** licensure, Medicaid, malpractice territory, tax nexus, and often an early arrival at the [MSO structure](https://mso.getlemma.com).
### D. Hybrid
Insurance base plus cash lines plus telehealth follow-ups. The risks are the seams: keep cash prices consistent with GFE duties, never routinely waive copays on insured services (an inducement/AKS problem), and make sure the PM system segregates the streams so [reconciliation](/concepts/reconciliation) stays possible.
## Part 3: Patient payment stack
* **Card processing:** rates, card-on-file, surcharge rules (state law plus payer contracts).
* **Pre-service collection:** eligibility → estimate → deposit or card authorization. With high deductibles, this is the difference between 95% and 70% patient collection.
* **Third-party financing (Cherry, Sunbit, CareCredit et al.):** practice paid upfront minus a merchant fee; patient repays the financer ([landscape](https://practicesignal.com/dental/compare/carecredit-vs-sunbit-vs-cherry)). Diligence before signing: merchant fee by plan length, approval rates for your demographics, who services the loan (their collections behavior is your brand), deferred-interest disclosure (regulators are watching medical credit products), and refund/chargeback flow when treatment plans change. Offer financing at treatment-plan presentation, not at collections.
* **Self-carried plans:** no merchant fee, your A/R risk. Fine for small balances on card-on-file autopay.
* **Statements, dunning, and the [refund loop](/guides/send-patient-refunds).**
## Part 4: The recurring calendar
| Cadence | Obligations |
| ------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **Weekly** | [Reconciliation exceptions](/concepts/reconciliation) worked · denial queue touched · eligibility/estimates for next week · payroll approval |
| **Monthly** | [Financial hygiene checklist](/reference/checklists) · KPIs: collections vs. production, days in A/R, net collection rate, denial rate, new patients, patient-collection rate |
| **Quarterly** | CAQH re-attestation · estimated taxes · fee schedule audit (are top payers paying contract?) · financing-product review · access audit (departed staff still have logins more often than anyone admits) |
| **Annually** | HIPAA security risk analysis (45 C.F.R. § 164.308) · OSHA trainings · BAA inventory · malpractice renewal · corporate annual report · CLIA waiver · DEA (3-year) and license renewals · 1099s · backup restore test |
| **On change** | New clinician → [credentialing](/guides/get-credentialed) 90+ days ahead · address change → every payer, NPPES, CAQH, bank · **bank change → [full playbook](/guides/switch-banks)** · new state → Part 2C stack · payer deposits change shape → investigate same week |
If a task here has no owner in your practice, that's the finding.