The full launch roadmap sequences
everything with comfortable slack. This is the compressed version: four months
from decision to first patient. It works because almost nothing on the list
actually depends on the thing before it, the trick is starting the slow tasks
on day one and letting everything else run in parallel.
The one thing that does not compress is payer credentialing, 90 to 180 days
per payer, and it only starts once you have an entity, an EIN, and a Type 2
NPI. A 4-month launch means you will likely open before you’re in network.
Plan for it (see “Opening before the payers are ready” below) rather than
letting it surprise you.
Month 1, Create the machine
Everything this month exists to unblock credentialing and money.
The entity and identifiers, in the first two weeks. Form the entity
(which one), get the EIN the same day the
formation comes back, then the Type 2 NPI. Not a physician yourself? The
ownership structure changes, read Owning a practice when you’re not a
physician before forming anything.
Start credentialing the moment the NPI exists. CAQH profile, payer
applications for your top 4-6 payers, and Medicare via PECOS if you’ll see
Medicare patients (Get credentialed). Every day of
delay here is a day added to the end.
The money. Loan applications go out this month too, underwriting takes
4-8 weeks and you’ll want funds before the buildout invoices arrive
(Get a practice loan). Size the ask with the
startup cost calculator.
Open the bank accounts as soon as the EIN exists, operating, tax reserve,
and payroll (structure,
setup). Every enrollment and
application downstream asks for these details; locking them early means never
re-doing an EFT form.
Month 2, Build the container
Space. Sign the lease and start buildout. This is the month with the most
external dependency (landlords, contractors, permits), anything you can do to
shorten it, spend money on. An existing clinical space that needs paint beats
a shell that needs plumbing.
Systems. Pick the EHR/PM (how to choose) and the
clearinghouse together, they determine how claims leave and how remittances
come back. Get the demo account this month, not opening week.
People. Post for front-desk and clinical staff now; you want them hired in
month 3 so opening week isn’t their first week.
Month 3, Wire the money
Payer follow-up, weekly. Credentialing applications rot without pressure.
One owner-hour per week chasing every open application measurably shortens the
tail.
EFT/ERA enrollment for every payer that has contracted, as contracts come
back, portal registration, deposit account, remittance delivery
(the payer setup playbook, and the
per-payer directory for exact steps).
The patient-payment side. Choose and set up your
POS system, even an insurance-heavy practice
collects copays and deductibles from day one.
Payroll, malpractice, and the compliance floor. Payroll provider running
before the first hire’s first check; malpractice bound before the first
patient; HIPAA basics (BAAs with every vendor that touches PHI) done in an
afternoon, not discovered in an audit.
Month 4, Rehearse, then open
Test the full loop with fake patients. Schedule → intake → chart → code →
claim → clearinghouse acceptance. Run a real card on the POS and void it. Send
a test claim to your largest contracted payer and watch it hit accepted
status. The practices that skip the rehearsal find the broken link in the
revenue chain 45 days after opening, when the first denials arrive.
Soft-open in week 3 with a light schedule, friends-and-family volume that
exercises every system while mistakes are cheap.
Opening before the payers are ready
If you open in month 4, some payer contracts will still be pending. Your
options, roughly in order of preference: see those patients out-of-network
with a clear cost conversation (works where you have out-of-network benefits
to bill); run cash-pay with superbills until contracts land
(how superbills work); or in some states
and specialties, bill under a supervising/credentialed colleague, this
one is regulated and payer-specific, so confirm the rules before relying on
it. What you should not do is hold claims and hope: timely-filing clocks run
from date of service.
What this plan assumes
A straightforward single location, financing that clears underwriting, and no
buildout surprises. Buying an existing practice moves faster (the machine
already exists, see Buy a practice); heavy
construction or a hospital-adjacent specialty moves slower. When in doubt, the
full roadmap shows the same
tasks with the dependencies drawn out.