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Session 1: Setting Up Your Business (Part 1)

Starting a business requires setting up the necessary foundation and basic infrastructure to ensure you are legally protected moving forward. Let’s step through the most straightforward part about starting a private practice: the actual logistics of forming a business.

 
 

1. Naming your business

Before you can begin anything else, you will first need a business name. Your business name is the first thing that people see and hear, so it is important to ensure it is memorable and easy to sound out. Here are some tips when you are naming your new business:

  • Consider using words that are commonly used and are pleasant sounding 
    • Extra points if you can use words that can hit emotional nerves that invoke feelings of joy and positivity! 
  • Avoid names that are too lengthy or have too many syllables.
  • Using your name in your business name can also work, but a clever play with elements of your name within it also helps create something more personalized and can showcase your personality and character.
  • Make sure that no other business has it claimed online by searching online for other businesses or trademarks
  • When you’ve decided on the name, make sure you register the web domain name! There are plenty of domain-registering companies out there, such as:
  • If you decide to build your website on a hosted platform (such as Squarespace or Wix), they often provide the option of purchasing the web domain through them so you can link your custom domain to the website.

Don’t worry if it takes awhile to decide on a name; often times, creating a memorable name that sticks will likely take multiple iterations.  It's also a great opportunity to start getting in the habit of asking others (like your board of advisors) for feedback, and don’t be afraid of asking for very critical feedback.  It is better to have it be judged by people you know!

 

2.  Forming a business entity

Forming a business entity are highly important because of the following reasons:

  1. Forming a business entity can offer tax benefits and advantages.
  2. It projects a professional image, so that it encourages consumer confidence in your business and its services.
  3. It may protect you from personal liability, depending on the type of business structure you form.

You may want to consult with a lawyer before choosing a business structure (e.g. sole proprietorship, corporation, partnership, or LLC), and understand the benefits of each structure depending on what you want to do with your business. We definitely highly recommend that you chat with a lawyer as each state may differ, in particular around professional corporation requirements that may or may not apply to the dietitian license. Your local Small Business Administration is also a good place to research your business structure options. Online options, like LegalZoom, also provide services to help set up your business.

Once you have officially formed a business entity, there are still a few additional steps to follow up on:

  • Don’t forget to register your business with both the state and the city that you are running your practice in. You will need your EIN for this (see below).
  • Depending on the name of your business, you may also be required to file a Fictitious Business Name with your City Recorder through a DBA (“Doing Business As”) certificate. This is required if the name of your business does not include the surname of the owner or the nature of the business is not clearly evident by the name.
    • Once you file your DBA, you must publish it in a newspaper of general circulation within 30 days from when you filed. This typically costs around $15-20.  
    • Perform a web search for “Fictitious Name Filing” along with your city name to find a local newspaper that can help you publish it.

 

3. Obtain your EIN and NPI

EIN, also referred to as a Tax Identification Number (TIN), is a unique nine-digit number used to identify your business for federal tax purposes. It is highly recommended as a best business practice, especially if you plan to handle insurance in any way:

  • In-network: Health insurance companies require that you have an EIN to become an in-network provider.
  • Out-of-network: If a private pay patient asks you to provide a superbill so they can submit an out-of-network claim, you need to provide a tax ID. If you do not have an EIN, you will have to provide your highly-sensitive SSN.

You need to have your business entity set up prior to applying for an EIN, so you may be able to request it as part of the services while you are setting up your business entity. Meeting with an accountant can also help save you time and ensure your EIN setup is as seamless as possible.

NPI is a unique ten-digit ID number issued to healthcare providers. Having a NPI will help indicate to potential clients that you are a verified and registered health care provider, as listed in a national registry system designated by the Centers for Medicare and Medicaid Services (CMS).  

Having a NPI will be required if you accept insurance, and also necessary when providing a superbill to your out-of-pocket patients when they submit for an out-of-network reimbursement

To get started, apply here! It's an estimated 20-minute process, and you should receive your NPI within a few business days.

 

4. Obtain professional liability insurance

As a healthcare provider, malpractice insurance is necessary to protect your business financially in the event of a malpractice lawsuit, which is offered by Proliability and other risk management companies.

Carrying liability insurance is a critical best business practice because it:

  1. Provides you and your business with financial protection
  2. Offers financial compensation for the consumer public in the event of damages caused by you as a health care provider.  Your clients will have a sense of security when they work with you as a provider.

If you are an AND member, you are eligible for discounts. Sign in to your account and scroll down to the fixed navigation bar to “Member Benefits” and click on Member Advantage Program. You will then find a link to Mercer Consumer to obtain a discount code.


Activity

If you haven't done so yet, here is a step-by-step summary of how you can set up your business.

STEP 1: Decide on a business name and purchase your web domain.

STEP 2: Identify and form a business entity structure that is right for you. 

STEP 3: Obtain your EIN and NPI

STEP 4: Register your business with both your city and state.

OPTIONAL STEP: File a DBA with your City Recorder and publish the name in a local newspaper

STEP 5: Obtain professional liability insurance for your business.

If you get through all of these outlined steps, this covers the majority of setting up a legitimate business and private practice. 

Congratulations! You are now set up with the foundation to start your business!



Session 2: Setting Up Your Business (Part 2)

Once you’ve gone through the steps outlined in Session 1, you are all set up with a legitimate business!  However, there are still a few loose ends to tie up before you start taking clients, so let’s go ahead and discuss what’s left.

 
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1. Set up a business banking account

It's important to always remember to separate your personal account from your business account. Depending on the type of business structure that you set up, there are potential legal implications if you are ever audited and it appears that you are using your business for personal expenses.  Starting a business banking account is typically free to start, and the bank can also help you get set up with a business debit and credit card.

 

2. Apply for a business credit card to help you make initial purchases that you need to get your office ready.

If you don’t have a business card yet, you can personally pay with your own personal accounts and indicate later in your taxes that you made a personal contribution as the business owner to your expenses.

Please note: Check with your accountant on how to appropriately indicate this on your taxes!

 

3. Get a credit card reader so you can accept payments through credit card or debit card.  

Research the readers your bank has to offer and other well-known companies.  Typically, there is a 3% transaction fee associated with each charge, and most readers can attach to your smart device (like your phone or tablet) and don’t require batching at the end of the day.

One great option is Square: they will send you a free reader and also have a great online invoicing feature if you want people to pay for a service upfront.

 

4. Set up a business email.

Having a professional business domain email is definitely recommended to help project your business image (i.e. @yourbusiness.com instead of @gmail.com). 

One easy way to get started is to use G-Suite: it is $5 per user email set up with your business web domain that you purchased, and there is even a way to set up HIPAA-compliance

 

5. Take professional photos.

First impressions are so important, so having high-quality photos that help potential clients see who you are will make your initial interactions more personable and relatable.  Many websites now showcase more lifestyle photos, instead of head shots where you are looking directly into the camera. This helps capture more of your personality and helps them picture who you are in your element.


 

6. Set up a website

A web presence is usually one of the first places that people will look up to know more about your business. Getting a basic website up and running is a necessary component of doing business in this modern age, here are a few tips on your options:

  • Click here to read the steps in building your own website if want to create your own DIY website. 
  • If time is an issue or you want to invest in developing a more polished brand on your website, consider in investing in professional web design. For example, WellSeek and our creative marketing partner LR Creative offer web design packages that can help you save time on getting a beautifully-designed, professional site built. Brand development is an essential component for having a cohesive website to target your ideal audience (which we talk about in Module 5).  If you aren't able to spend time or money to develop your brand, at a minimum, get a basic website up first and improve it as you go. It will always be a work in process!
  • Don't wait to have a full-fledged website in order to have a web presence!  Create a single cover business page with some basic contact information, social media links, and form to capture email sign-ups of those who are interested in your business.  You will still have a place for people to land on and stay up-to-date with your progress, even as you’re getting your site up and running!


Session 3: Office Location

The next big decision you will have to make for your practice is your office location. Location is important because that factors greatly into how your initial customers can find you, and how often your existing customers visit. You want to be wherever your customers are and make it as convenient as possible to visit you.

 
 

Renting office space

One option to consider is renting office space from another health care professional, such as a physician or therapist, or at a health club. Renting an office space from another healthcare professional is beneficial especially if they have a well-established, functioning practice. Just make sure that your nutritional values align with the practice you will be working out of. 

This may also be an opportunity to jumpstart your own client base and business by:

  • Using the office free of rent or at a discounted rate
  • Being a contracted provider through the healthcare professional's business 
  • Leveraging their existing clientele for new referrals

Do keep in mind that they may charge a percentage fee for patient sessions, depending on how reliant you are on their referral and office space.

Another option is to rent temporary, part-time office space. Regus is a company that has nationwide executive offices with as much or as little space as you need.

 

Accessibility to your office

One factor to consider when choosing an office location is public transportation. For example:

  • How close is your potential office to a bus stop or public transportation?
  • How accessible is it to parking?
  • Is there plenty of parking and is it free?
  • If you’re on a busy street, how easy is it for cars to get in and out of your parking lot? 

How easy the office is for you to get to is equally important. Since this is your business, you should have the luxury of an easy commute.

 

Costs involved with renting an office space 

Rent composes the major portion of your ongoing facilities expense, but consider extras such as utilities. They can sometimes be included in some leases, but not in others. If they are not included, ask the building manager what you can expect for the monthly cost. Other questions to consider:

  • If you have to provide your own janitorial service, what will it cost?
  • Do you have to pay extra for parking as a tenant?

Consider all your location-related expenses, and factor them into your decision.

 

Importance of an office vs. home office 

A permanent office is a necessity for increasing the perceived value of your business to potential clients.  Most insurance companies even require that you have a professional office space for consulting with clients. 

Setting up a home office can be helpful for when you are taking virtual consultations with patients.  Some dietitians may even set up a home office where patients meet them, or they may meet at the home of their clients.  However, we do not recommend that because of the higher risk of a potentially harmful situation.

 

The office set-up 

One of the first things you need to obtain is an office phone number, fax line and internet. As soon as you have these in place you can get your business cards printed.  If you are going through insurance credentialing and contracting, an office phone number will be necessary.

The first impression the client has of your office will determine their initial comfort level. The more comfortable your client feels, the more open and trusting they will be with you.

One way to help clients feel more comfortable is to have the session around a coffee table and have them sit on a couch. Talking to them from behind a desk is intimidating.  Offer water or even coffee before you begin. Have mints, tissues and pens easily accessible.

 

Office supplies

The ones that you will likely need are:

  • Chairs, table, desk
  • Fax/printer
  • Filing system
  • Scale
  • Clip boards
  • Pens, paper, stapler, tape, etc
  • Wall clock
  • Office phone
  • Computer
  • Paper shredder 

The following are optional, but highly recommended to have over time:

  • Magazines: Today’s Dietitian, Food and Nutrition, etc
  • Water, coffee (Keurig)
  • Mini fridge
  • Tissues
  • Rugs
  • Wall art
  • Candles, framed quotes, or other inspiring and comforting decor


Section 4: Managing Finances

Before we discuss the areas to consider when establishing a bookkeeping system, it’s helpful to understand exactly what bookkeeping is, and how it differs from accounting. Bookkeeping is the day-to-day process of recording transactions, categorizing them, and reconciling bank statements. Accounting is a higher level process that looks at the business’ overall progress and will make decisions based on all the information collected by the bookkeeper.

You will need both, but may decide to reach out to an accounting professional. Again, your time as a dietitian is valuable and it may be an opportunity cost if you try to do it all yourself. If you find you are staying up late or working through the weekend to keep up with the financials of your business, then you aren’t showing up fully for your clients, your revenue source. Doing too much causes stress which leads to burnout.

 
 

Keeping the books

Here are some of the key tips to keep in mind:

  1. You can make use of software such as QuickBooks, or simply use an Excel spreadsheet.
  2. If this is not your area of expertise or you are new to the software, this is an opportunity to hire a part-time bookkeeper. Another idea is to take a course on how to use QuickBooks.
  3. Any transaction that occurs will need to be recorded. This includes payments from clients and insurance companies, rent, utilities, payments to yourself and all other expenses. If you are keeping your own books as you continue to grow, it might be helpful to do this several times a week.
  4. Save receipts from all the purchases you make.  Also make copies of any checks you write. Then file them in chronological order. This will make doing the business’ taxes much easier.
  5. You should log any vehicle miles that are work-related, including to the following locations:
  • Bank
  • Store
  • Meetings
  • Events
  • Business lunches or dinners

 

How to track your revenue and referral sources

Maintaining a good understanding of your marketing referral sources is key to maximizing your efforts.  The first step is to identify your most profitable referral sources by keeping track of how each client finds you. 

The best referral source will maximize the number of people you reach with the least amount of effort. Use analytic tools, such as Google Analytics or Facebook Ads to keep track of what is generating website traffic or client revenue for you. If a source isn’t producing many referrals, ask yourself: 

  • How could it be improved to drive revenue?
  • Can you shift your efforts to a more profitable source?

 

Insurance claims

If you accept health insurance, it is incredibly important to check the status of the claims you have submitted. It is inevitable that you will have to deal with denied insurance claims and it can be quite frustrating. Even when you do everything right on your end, the claim does not always get paid according to the eligibility check. 

If a claim has been denied and was not paid correctly, you need to investigate why and how it can get paid correctly. If you are not aware of claims that aren’t getting paid, a client could see you multiple times and their balance will continue to grow. For more discussion around this topic, check out "9 Additional Tips for Accepting Insurance" in Module 3.

Tracking the status of claims and investigating denied claims can be extremely time-consuming, so one option is working with a claims processor, such as Healthy Bytes, who can help alleviate some of this effort and stress off your shoulders for a fee.

 

Invoices

Be sure to keep track of any client unpaid balances. Send monthly invoices for unpaid balances. Charge interest each month and give a time frame for when the balance must be paid in full.

Example: In my practice, I charge 1.5% interest each month a balance goes unpaid in order to keep my clients accountable. The client has 3 months to pay their balance. I do have a statement about this on my policy form each new client signs at the initial consultation.