[00:00:01] Speaker A: All right, welcome to the first episode of our newly rebranded podcast, Chirocast. I'm Doctor Stephanie Brown and I'm thrilled to be one of your new hosts.
[00:00:11] Speaker B: And I'm Danielle. I'm excited to join Stephanie as your co host for this exciting journey.
[00:00:15] Speaker A: Yeah, we're really excited to introduce you to Chirocast with a brand new name, a fresh look in refreshed format. Our goal is to bring you engaging conversation in and about the chiropractic profession, covering the latest trends, challenges and insights.
[00:00:30] Speaker B: That's right, we'll be diving into hot topics, featuring in depth interviews with industry leaders and sharing practical tips to enhance your practice. Plus, we're introducing a new segment where we read and respond to your emails. We love hearing from you, so send your questions and comments to chirocastyrotuch.com dot.
[00:00:50] Speaker A: We also want to let you know that all of our previous episodes are still available for you to enjoy the you can find them on your favorite streaming platforms and our YouTube channel. So if you're new here, there's plenty of great content to catch up on.
[00:01:02] Speaker B: Absolutely. We're thrilled to kick off this new chapter with you. Now, let's dive into today's topic, which is tips for getting your practice off the ground.
[00:01:18] Speaker A: Thanks for joining. This is doctor Stephanie Brown and I am with the Cairo Touch onboarding team. And this is Danielle, if you'd like to introduce yourself.
[00:01:28] Speaker B: Yeah, I am new to the team. I am leading the strategic partnerships here at Cairo Touch, so I am excited for our topic today.
[00:01:39] Speaker A: Awesome. So just a little bit more about me. I did practice for 15 years full time and I came to Cairo touch towards the end of 2022 and I am the manager for our onboarding team. So both of our servers based and cloud based versions and I run a lot of our webinars and doing this too, apparently. So lots of fun. We're happy to have you, Danielle. I'm really excited for the work you're going to do and the people that you'll get to meet. And I'm really excited about this podcast and with what I do, for sure, talking with offices pretty much all day, we encounter a lot of topics that I know people have challenges with and one of those which I thought would be a good topic to start with for today would be this will help multiple people. But it really came to mind with me when we are interacting with brand new doctors, you know, they are just getting out there in the world and they really need to basically figure out what they are doing.
Likewise, we encounter a lot of providers too that maybe took some time off from practice or maybe they've been an associate in an office for a while and they want to go off on their own.
So, you know, and there's other occasions where my personal favorite I love actually when doctors retire and then want to start practice again.
You know, they just relocate and have to kind of start over and maybe they practice for a long time and just don't remember where to start.
So a lot of that is going to interact with how you might have to set up your software system and different decisions you have to make. So I thought it would be neat to kind of go through some of the stuff that they might need to know to help them out so that they can sort of get for success here.
[00:03:33] Speaker B: Yeah, I agree. There are so many moving parts when it comes to opening your first practice or moving or expanding and there are a lot of things that aren't in the forefront of your mind.
So excited to dive into that and help as many people as we can.
[00:03:50] Speaker A: Yeah, absolutely. Also doctors who are in practice, but maybe they're going to change their tax id number, their business structure or their business name or maybe their name. So I'm not the pro in that. I've never had to change my name. But when we practiced, when I was in practice full time we did go through a name and tax id change and it was painful.
So there's not really a way to make it not painful other than trying to plan ahead as best as possible.
So I think the first thing I thought we would jump on is NPI. So when I was in school they made us get our personal npis when we were in school still. And I'm guessing it's because we needed it for clinic maybe, I'm not sure, but we had to register and set ourselves up as students essentially. I think that was the option. So that's all well and good, but once you get out of school you already have that personal NPI if you already signed up for it. So it's a really good idea to get back to that NPI website to update your profile because then you need to tell it you've graduated and you're a doctor now and you need to get that updated.
If there is someone who maybe never made a personal NPI then of course they would just go to that same website and start from scratch.
[00:05:15] Speaker B: So I've actually dealt with a handful of newer and seasoned docs that weren't familiar with the nomenclature NPI, much less where to go to apply for one which was a little scary because they had been 15 years in practice and I wasn't quite sure how billing was going without an NPI. But there are a lot of folks out there that either don't know what an NPI is or if they do, they're not sure where to go, why it's important, and why they need to keep up and maintain their NPI over the years, especially, like you mentioned, with changing your name, changing your practice type. Medicare's huge when it comes to NPI. So I think maintaining those is probably the most important piece of being in practice.
[00:06:09] Speaker A: Yeah. So we're going to have like a little worksheet and we're going to gather some notes. And if you're listening in and you think that this would be helpful information for you, you can just drop us an
[email protected]. we'll spell it out for you later. So we'll have some links and things in there and some notes from today's session. But. So this always killed me because what does all this even mean? But anyways, the website is the national plan and provider enumeration system, or it's NPPEs dot CMS, dot HSS, dot gov. So this is a government website.
And so back in the day, you had to have, I think all providers used to be identified via their Social Security number. And, you know, people got smart and said, you know, that's not the greatest idea that we've ever had. So I'm sure they went through the exciting process of forcing everyone to get an NPI. So it's basically a ten digit number that is unique to you, that will identify you to insurance companies and any other parties that you work with, especially when it comes to billing and credentialing. But maybe, you know, your malpractice insurance might want to know it and things like that, too.
[00:07:29] Speaker B: It's like an identifier. It's like your Social Security number, but for being a doctor and all doctors have one, anybody that's licensed to practice anything will have an NPI.
[00:07:40] Speaker A: Yes. So if you don't have one, that's probably step one. You want to get that personal NPI set up.
On the same note, your facility, if you are opening brick and mortar structure, going to also likely need a group NPI. So there's various reasons as to why you might not need one, but let's just pretend for the moment that you do. So on the NPI website. You can also register your office to have a group NPI, also known as type two NPI, or organization NPI, I think is the other name people call it.
[00:08:19] Speaker B: Yeah.
[00:08:20] Speaker A: So don't get those mixed up because they're totally different from each other, even though they seem like they're the same and really important to have that in, like, your vault of information about yourself in your practice that you're going to keep right next door to, like, your tax id number.
[00:08:36] Speaker B: Don't share them.
Your NPI is your own. And I would say that it's fraudulent to share them across different folks. So keep that in mind.
[00:08:49] Speaker A: Yeah. Correct. You can't bill under someone else's NPI unless we'll talk about that later. There's various situations, but as the rendering provider, you would only be billing as you doing a service. So that's where you're definitely not using someone else's for sure. Awesome. So we've got personal NPi and group NPI. So another number you're probably gonna need is a tax id number. Again, all of us have Social Security numbers. And if you're first starting out, you might think it's an okay idea to just be a sole proprietor and use your Social Security number. But that's a horrible idea. Please don't do that.
That's my personal opinion. I just think it's not secure. Cause if you have to give a super bill to a patient, they're getting your Social Security number. And I think that's a bad idea.
[00:09:39] Speaker B: And if you want to expand or add employees later on, it's not fun to transition everything over and change everything in the practice.
[00:09:48] Speaker A: Yeah, absolutely. Correct. And so actually, let's rewind for a second. I think maybe if you're opening new, a next best thing to have organized is actually going to be maybe a relationship with a business attorney and an accountant.
[00:10:02] Speaker B: Yep.
[00:10:03] Speaker A: Oh, yeah.
Business attorney in your state. So please, I see this all the time. Don't go on Facebook and ask your friends, you know, does someone have a good example of a contractor? Can someone read my commercial lease? Don't do that. Please find a lawyer in your state, in your area who can help you with that.
[00:10:26] Speaker B: No legal zoom, no rocket lawyer. Yeah, probably not the best idea.
[00:10:31] Speaker A: Yeah. You know, in my experience, maybe a place to start might be like a. If you know a real estate agent locally, they would have good contacts to help you find a real estate attorney that deals with commercial business leases.
If you don't want to just cold turkey it in like, open. I was going to say open the phone book, but I don't know how many people have those anymore.
But yeah, getting a reference for a business attorney is a good idea. If you know somebody in your area, but try to find someone near you that you can meet with, talk with, and at the very least, somebody licensed in your state advise you on those things. Not the, you know, law, University of Facebook.
[00:11:07] Speaker B: Right. Or state associations. I'd say use, use them as a resource, reach out network networking is never a bad thing, especially in chiropractic.
[00:11:17] Speaker A: Yeah, yeah. State association is a great place to check, too, for sure.
So get a business attorney because they'll be able to advise you on all those things like leases, occupancy, like just stuff like that. And then hand in hand, get an accountant. I mean, you've got to. And that's someone you're going to have a relationship with for hopefully a very long time.
Certainly you don't know what you don't know in the beginning when you don't know it. So maybe you switch some way down the line. But getting an accountant who has experience helping people start businesses, especially, that doesn't mind collaborating maybe with your business attorney to help you figure out what the best structure is going to be for your business is really important.
[00:12:00] Speaker B: Yeah, a roadmap, really, you really need a roadmap for your business. Whether you are going to go into a brick and mortar or start off as an associate, having a plan in place for when the time comes is going to be crucial.
[00:12:13] Speaker A: Yep. And I'm, I kind of, I want to harp on all this because as I stated before, when I was in full time practice, the owner was a sole proprietor for the first, I don't know, he was probably like that for too long. But at least for the first five or six years that I was with him. And then partway through that, he decided to switch his business structure, which required him to change his tax id number and he changed his business name. And it is a lot of work. So if you just want to get off the ground and you rush it, you're going to have to redo everything if you end up changing your business structure. So it's really a great idea to plan ahead, figure out if you're going to be a sole proprietor with a tax id number or are you going to be an LLC.
Here in New York state, we'd have to be a pllc. So I also would want to work with a lawyer to make sure that I didn't waste my time filling out the wrong paperwork, because you got to fill out the right paperwork.
Or maybe in your state you're going to be a corporation. You know, whatever those different designations are, they vary by state. And you really want to make sure that you pick out the one that's going to be the best for you in the beginning, if you can.
[00:13:27] Speaker B: So winging it is not a good idea.
[00:13:29] Speaker A: No, no. This is not like I'm going to the grocery store without a shopping list.
That's like, I do that every Sunday. You don't want to do that with your practice.
You want a list for sure.
[00:13:44] Speaker B: Agreed. I've helped many of practices with the transition over, but also having to clean up a mess because they bought a practice from someone and it was their first time and it's almost the same as starting over, really. But you're inheriting potential messes and there were questions that weren't asked initially.
I think having an attorney from the jump is probably going to be a great idea no matter what.
[00:14:12] Speaker A: Yeah, absolutely. Okay, so make sure you have an attorney and an accountant who can properly advise you. They're going to work together to make sure that you set up the right business structure. And then you will get your tax id number. Getting your tax id number. Let's talk about that. It's free. You don't have to pay money to get a tax id number, also known as EiN, which is. I think it's employee identification number. Yeah, yeah, I'm pretty sure that's what it is. So it's free. You don't have to spend money to get that. The IR's is happy to provide one to you so that they can bill you your taxes.
[00:14:51] Speaker B: And I wouldn't go out and just go online and go get one because like you mentioned, you have to know what type of business you are before you start that process. So if you show up to an attorney's office, say, hey, here's my tax id. But you've signed up for a sole proprietorship. You now have a lot of work on your hands.
[00:15:09] Speaker A: Yeah. You have to start over, basically, if they advise you that you're gonna, you should be a different business structure.
[00:15:14] Speaker B: Yeah.
[00:15:15] Speaker A: So you would just go to the IR's website and find the area that says tax id and sign up for one.
[00:15:21] Speaker B: It's like a wizard. It walks you through everything. Super simple.
[00:15:24] Speaker A: Yeah.
If we can pause, I can share a story here. Do you want to hear a funny story?
[00:15:29] Speaker B: Yes.
[00:15:30] Speaker A: Slash not funny. So I practice full time and I decided it was time for a change. And with the support of my former employer, I transitioned out of his office. I came here to Chiro touch, but I didn't want to stop practicing. I really wanted to maintain those relationships, take care of those patients that I had been working with for a long time and just keep my hand in the game. So I had this all planned out in my head.
Let's see, what order did I do things in?
I did exactly what we probably said you shouldn't have. But I had been thinking about it for so long that I felt comfortable enough that I was just making the decisions. And then I executed them. So one day I got in the car. In my instance, I did decide to be a sole proprietor. And to do that I just had to go to my county office building and fill out the DBA paperwork doing business as, which we'll talk about again in a second too. So I just went downtown and pulled out the paperwork that said, hey, I'm a business now. Filed it with the county clerk. Nobody was there. It was great. And then I got in my car and I drove to the bank. And in the parking lot at the bank, I went to the IR's website and I applied for my Social Security number or no, I already had that. I applied for my tax id number.
[00:16:50] Speaker B: Your ein?
[00:16:51] Speaker A: Yes. Don't use your Social Security number. So I applied for my tax id number. I sat in my car and waited. I got the email. It was approved. They send you a letter and it's very official looking and you're going to need it for the rest of your life, and so keep that handy. And then I walked into the bank with my phone and said, I need to open a business banking account. And I, they actually asked me to forward the letter to the guy that was helping me at the bank. So I forwarded the email from the IR's to the guy at the bank and I handed him a check for my personal bank account to seed some funds in there. And that was it. I had a business, so that's what I did. Now later on, I was checking my credit card statement and I realized, I don't know how I didn't know at the time, but I was obviously kind of nervous. And as we're discussing, it's not like I had a plan written out that I had really. I mean, I had, I thought I knew what I was doing, but like, even then, you know, I didn't know. It turns out I had found, when I googled to find the IR's website, it actually was like a different website that looked like the IRS's website.
Yeah, this is a true story that did help me get my tax id number. But they charged me, like, dollar 200. I'll go back and find it. But they charged me like, two or $300 to get my tax id number.
[00:18:06] Speaker B: Like a third party facilitator type.
[00:18:08] Speaker A: Exactly. So it wasn't fraudulent. Like, they didn't steal my information, but good lord, I entered everything about myself through this portal on these people's website. They charged me for it. It did interface and get sent over to the IR's, so it was legit. But, like, I paid $300 for my tax id number.
I was pissed. So I sent them the nasty gram. I figured this out probably in, like, January, like three or four months later after I done all of this stuff and was like, hey, this is fraud or whatever. And they were like, no, like, we're very clear with all the things you have to acknowledge that. Like, we're not the IR's. We're just helping you. And I was like, oh, son of a gun. That was. I was. I was not happy. But, I mean, at the end of the day, I guess, you know, it's kind of a stupid tack, so to speak. Which is why if this podcast helps one person avoid that mistake, then I would feel like it was worth it. So, yeah, again, we'll have a little handout, and if you want to make sure you're going to the actual IR's website, we'll try to make sure it's very clear where you're supposed to go to actually get the tax id number and not get ripped off. So you guys can all learn from my mistake. Yay.
[00:19:29] Speaker B: You saved everybody $300.
[00:19:31] Speaker A: I hope so. Yes. You can send it to me as a gift to Kairoto.
[00:19:36] Speaker B: Thank you.
[00:19:38] Speaker A: Perfect. We've got NPIs handled. Oh, well, once you get your business name set up and, like, then figure out where you're practicing, that might be when you return to the NPI website to do your group NPI. So, just to be clear, you might not do your group NPI at the same time as your personal NPA.
[00:19:54] Speaker B: Yeah, you have to have an address, you have to have the business name and lots of other things that if you don't have a brick and mortar yet, you wouldn't have the group yet.
[00:20:03] Speaker A: Yes, exactly. Okay, great.
Oh, we went to the IR's, and now we have to go to the bank. So in my example, I went to the bank. Just a note on, like, picking your bank. You know, that's a personal decision. But in my area, we have a lot of good credit unions.
They're locally or regionally owned, so just I don't know. I think researching a bank to use is a good idea. Talk to people. How business friendly are they? You know, things like that. Lots of different options. But I know with my bank, I don't pay any fees at all, so that's a good thing. When you get into business banking, sometimes there are fees if you don't have a minimum balance or whatever, things like that, which is fine, but you just need to be aware of what you're getting into and what the fees are going to be.
Side note, random. I know someone that owned a coffee shop. They actually used to get charged by their bank for depositing cash.
Um, so maybe you want to find out things like that. Do you get charged for depositing checks? Charged for depositing cash? Like, you know, do you want that for your business? And if not, maybe you're gonna shop around.
[00:21:14] Speaker B: So I didn't even think about that.
[00:21:16] Speaker A: Yeah, it's wild.
[00:21:17] Speaker B: Yeah. That wouldn't be something that I immediately was like, here's on the list of things to do. I mean, obviously having a business bank account, but finding the right fit for which bank to use, that's not something that I would immediately have thought of.
[00:21:30] Speaker A: Yeah, I mean, if you get charged for depositing cash, you could just put it in a shoebox under your bed, probably, but put it in the might not go over well.
What about funding? Do you have any comments on funding?
[00:21:45] Speaker B: Ooh, what do you mean?
[00:21:47] Speaker A: Well, like, if you need startup capital or where are you going to get the money to start your practice? That could probably be a whole other episode.
[00:21:55] Speaker B: Oh, yeah, because, I mean, you've got to think there. I mean, if you're coming right out of school, there are going to be a handful of folks that their family's been in practice for many, many years, and maybe they're inheriting a practice so they're not having to come out of pocket thousands of dollars right away. But then there are going to be those that they immediately are seeking a business loan and might not have collateral for things of that nature. So I've not actually personally dealt with offices that were seeking funding, but I imagine there are grants, state specific grants, and different funding avenues for them to look into.
[00:22:35] Speaker A: Absolutely. Especially also if you're an associate and you think there's any chance that you will want to go out on your own. I mean, I know a lot of us want to pay down our student loans as fast as we can, but you might want to be smart about trying to save some money at the same time so that you can go out on your own. Also, you need to have the conversation with yourself, because you don't need the newest and greatest, best thing of everything.
My parents bought me a portable table for Christmas when I was a student in 2007, and it's literally what is sitting behind me and what I used to adjust people on.
[00:23:16] Speaker B: Still going? Still kicking?
[00:23:18] Speaker A: Yeah, it looks brand new still. It's wonderful. So I have a lifetimer for anybody wondering. I think they make great tables. I've been very happy with it. It's sturdy, it's comfortable. I don't know what the weight limit is, but I am positive that I've challenged it with some.
It has a drop piece, um, hash.
[00:23:37] Speaker B: Beast of a Cairo.
[00:23:39] Speaker A: Yeah. Good times. By the way, they're not sponsoring us, so this is just like, letting everyone know my experience. Um, but I've had a great experience with that table. I like it a lot. It's been awesome. I mean, when I went to Parker earlier this year, I 100% was looking at tables. And, you know, the table I would want is probably, like 15 grand. But at the end of the day, I don't really need it right now or at all. It's more of a want, not a need of. And so I think, especially when you're starting out, you've got to be really reasonable about what you're starting with. And there are plenty of people that run busy, productive, and profitable practices that have a lifetime or table from 20 years ago, maybe.
So you do need equipment, but there's actually a pretty. There's a great group, actually on social media, on Facebook, that is, like, used chiropractic equipment for sale. I mean, there's stuff getting posted constantly. Tables, therapy equipment, you know, waiting room chairs. Sometimes it's local and you'd have to look for something near you, but sometimes people are shipping things. I actually got something from there, ultrasound and stim machine.
And so. Which was funny, by the way. I mean, I hadn't done ultrasound on someone in, like, 1012 years or something. And it's funny, I was sitting there and I was like, this is why I haven't done this in a long time.
But anyways, moving on. So, yeah, there's great opportunities to get used equipment locally for me, too. Like, we. I'm in a couple groups on Facebook that are local to my area, and every so often, somebody is posting that they need something or that they're looking to buy something. And sometimes you can find it in your area, too. So those are all avenues maybe, to find equipment for your office.
[00:25:29] Speaker B: I feel like when you're first starting out, going by slow and steady, like, pacing yourself is going to be important because like you said, you don't need the most new equipment. You don't need, you know, thousands and thousands of dollars worth of equipment just to start with. I would say that could be a goal, and finding a mentor could also be beneficial to help you walk through what those, those avenues look like initially.
[00:25:58] Speaker A: Also, I would say if you're just first starting out, especially, you don't need to go big. So you do not need a giant office.
You don't need a lot of space.
I know that I practice part time, but I don't know how big this room is, but it's not big. This is all I have. Um, I have one room and it's perfectly profitable. It serves my needs and it's great. So, um, yeah, I mean, you don't need a lot of space. Um, sometimes I think it's easy to get lulled into this idea of like, well, I'm gonna, my business is gonna grow and I want to grow into something. There is truth to that to a certain extent. But if you go too big, you're just gonna end up with rooms you're not using. And then eventually, either right away or eventually, you're just going to, like, see these empty rooms and it's just money floating right out the window because you're going to pay per square foot, obviously. So I think it's important to right size how big your office is going to be at first. Again, maybe this is a good thing to hop on Facebook and ask colleagues locally networking, but ask other people, like, how big is your office? How big is your adjusting room?
Just try to find these things out so that you don't go too big. So like I said, it's not bad to grow into something, but it's not great if you go, you've got too much space and then you don't grow into it. The other thing, too is like, your square footage is not the only thing that you might have to grow into your location, other amenities to your building. So even if you get a office that is the size you think you might want for the rest of your career, there may be other things that are playing into that that you end up deciding down the road, I'm not going to stay here. And then you're moving. Right? And then you maybe would have paid for all that extra square footage when you didn't need to. So if someone were to ask, I think in this case, a little bit smaller is probably going to be better because it's going to help keep your overhead down, make it more affordable. And then as you grow, you can decide what other things might be more important to you. And then if you're going to look for a new location, at that point, you're armed with that experience and that information, and then you can maybe, probably find something that'll be a better fit once you're ready.
[00:28:15] Speaker B: You know, what's underrated, I think, is gyms. Reaching out to your, I mean, not franchise, maybe even franchise gyms, but smaller mom and pop gyms that have those extra rooms, they're not being used. It's going to not only help you with networking, but also perhaps that's your starting point. A small room in a gym that is going to come with patients, potential patients. I know there. I've worked with a handful of Cairos that that was their starting point was working out of a gym, which wasn't something that I had ever heard of. But then I started to see them more and more as I go. It's kind of like getting a new car. You get a new car, and then that's the only car you see when you're going down the road. But I think that's a really good starting point is, you know, in a PT office or in a gym or even being a traveling chiropractor, which is not too common, but it's not unheard of.
[00:29:10] Speaker A: Mm hmm. Yeah, I actually, the gym that I go to, there's a physical therapist there. She's great. I've seen her before when I've needed help and had problems. She already had a chiropractor, so she hasn't seen me. But that's okay. We still have that professional courtesy and respect, and her and I do have mutual patients. So some of my people will come in to see me, and they're like, you know, I saw Kelsey last week, blah, blah, blah. And I'm like, okay, great. What did she say in moving on? So, um, you know, that's not me. Like, I'm not in the gym, obviously. Um, but, you know, Kelsey is, and she actually is in, um, she's got more than one location. She's kind of on opposite sides of our county. So she's been able to leverage that by renting existing space that other business owners had already started, that were looking for, um, people to help fill their empty space because maybe they thought too big and have an extra room.
So that's a really good point, too. Great way to start out one thing we didn't touch on yet is naming your business.
So one thing I want to jump on really quick with naming your office is there are some states that have really strict laws on what you can say in your business name. Do not have this dream about Doctor Joe's super duper. Best chiropractor office ever.
Because it's very likely that there's not a state in this country that is going to let you name your office, that there's a lot of laws governing, you know, you can't claim superiority or like things like that. Some states will say you have to have the word chiropractic in it, others are more lenient and it won't matter. So before you really get your heart set on something, you know, Joe super duper, perfect practice, or whatever it was, get a feel for where you want to go and start looking up what the laws might be because you might be limited in what you can choose from.
[00:31:09] Speaker B: So, like, not the crack house. Probably not a good idea.
[00:31:15] Speaker A: Don't say that, Danielle, because we're going to have to go find out if.
[00:31:18] Speaker B: Somebody'S office has that got to be a DBA somewhere.
[00:31:23] Speaker A: I would not put it past us. Let's just put it that way. By us, I mean chiropractors.
Yeah, that would be hilarious.
That's interesting, though. So, well, let's talk about that. Right? Like, what would you picture that office being like, what do you think they do there?
[00:31:39] Speaker B: You know, if I was doing a Google search and I was like, I need a chiropractor near me, and the first thing that popped up is the crack house. I'm going there because it's funny and it's a play on words. And then hopefully that is, it is a chiropractor that I'm showing up to.
[00:31:56] Speaker A: Well, I hope you visit their website first to see that there's that.
[00:32:01] Speaker B: But I mean, that would probably be the one that I would click on because it's not something that is, you know, everybody's picking the name, it's not generic, it sticks out and I'm weird. So I'm gonna, I'd like to tell my friends, like, yeah, I'm going to the crack house after work.
[00:32:18] Speaker A: That's really funny. Well, I will tell you that I would not go to the crack house because I don't do well with, like, this is gonna sound weird. I don't do well being like manually adjusted with like, you know, more traditional diversified adjustments. I don't respond well. So that's what I was gonna say. Like, you know, crack house chiropractic use the name of their practice to make it very clear what they probably have going on over there. Um, and so. But that's good because someone who might not want that type of service, or they just know they don't like it or they don't respond well to it, or they want to bring their baby to get adjusted and they don't think the crack house is the right place for babies first adjustments. Right. The name of the practice is telling you something about it. So from, like, a marketing standpoint, that's a great idea. But if you name your practice after yourself, like, I'm not naming my office brown chiropractic. Okay, first of all, brown is boring. It's a color. And, I mean, it's my last name, but it sucks not naming my office brown chiropractic. It also tells the patient absolutely nothing about what I do. It doesn't send any message at all. So everyone has different reasons as to why they want to name their office, what they want to name it, but, you know, what's in a name. So if you put a little more thought into it, you might be able to harness your office's name as part of, like, your marketing or business strategy, too.
[00:33:48] Speaker B: Yeah, I'd say even using AI, like chat, GPT, Google, Gemini, like, that didn't exist years ago, so you had to just come up with things off the top of your head. But AI, there are so many good ideas out there, and I would even venture to say it can tell you if it exists or not so that you can set yourself apart.
[00:34:08] Speaker A: Ooh, that's a good point. Okay, so the business names. Oh, gosh. Okay, so, like, in New York state here, for example, I can go to my county clerk's office and I can register any DBA as long as no one else has it. Right? But if someone else has my same business name in a county over, that's okay. It doesn't matter if it's just like a DBA, right? But I. If someone else in my state has that registered as, like, a company with the Department of State, I can still do a DBA here, but I would not be able to create another company with that name registered in the state because someone else already has that name. Did that make sense? So, again, depending on your state laws, there might be rules about what words you can use or what words you have to use, but there will also be rules that you can't use names already in use. So you need to find out what other people have already called their business. I think most states would have a searchable registry and that's a great place to check.
[00:35:12] Speaker B: Yeah. I would say even before you get to the tax id part, you want to make sure that what you're registering doesn't exist. Because I want to say the IR's, it'll flag you and say, nope, you can't move forward. This already exists. And instead of doing that and getting a headache, you want to make sure it doesn't exist already and go through names with colleagues and figure out if that's what you want to stick with, at least for the first couple years. Cause I want to say, you know, if you wanted to change it down the road, you can. It's not gonna be fun, but it's doable.
[00:35:45] Speaker A: Yeah. Some people will go, you'll set this up with your attorney first, but maybe you're naming your business doctor Stephanie's house of Chiropractic. And that's what I'm registering with the IR's for my PLLC here in New York state. I should go take that right now so no one else does.
But then depending again on your state and your structure, you may be able to go to your accounting clerk's office and register a DBA. So maybe my sign doesn't say Doctor Stephanie's house of Chiropractic, but it's just going to say house of chiropractic because that's my DBA. So again, though, they have rules about that too, in your area. So you might be able to set up your business and then operate under a business name that you've registered in your area. But again, you got to check all the things.
[00:36:31] Speaker B: Oh, yeah, I forgot about that piece. You forgot like your legal business name. But then what? You're allowed to operate as like with your signs and your advertising could get you in trouble if you don't do your research.
[00:36:43] Speaker A: Yes, most definitely. Okay, let's assume we got all those things handled and now you're ready to open. But you, first of all, here's the thing. If somebody's just asking, should I take insurance? That's a really personal decision to make. If I had to do it over again, I wouldn't.
It's a lot to get a handle of.
I question how much it's worth it.
Everyone probably already doesn't need to hear any of us talk about it because we all get it.
It's hard. So in and of itself, like, I get it, everyone's going to make that decision for themselves. That they do. So if you want my opinion, don't take insurance, but if you're going to anyways, because I take insurance. So I'm not trying to tell literally people what to do.
The first thing you probably want to do is address Medicare.
I remember and I know when I apply for to be a network with other like commercial insurance companies they asked me for my Medicare ID number and when I first got credentialed they wouldn't process my application without it.
[00:37:49] Speaker B: Your P ten, is that what you're referring to or Caqh?
[00:37:53] Speaker A: Yeah. Yep. Oh God, Caqh. So let's talk about that. If you're going to take insurance, you do need to probably definitely get credentialed or fill your application out on Caqh. I can't, I don't remember what that stands for. It's probably ridiculous, but yeah, it's basically a central repository, kind of where all the providers, many providers across the country will fill out all their stuff. So like name, address, where did you go to college, like all those kinds of things.
And then when you go to get credentialed with an insurance company they will look for you in that Caqh database and just draw all your information from there. They'll still make you fill out a ridiculously long application probably, but you know they'll corroborate it against what's in that database.
[00:38:42] Speaker B: Yeah, I would say, and if you are going to go the insurance route, it's not something where you decide, yeah, I'm going to take insurance and then you are in network with every insurance carrier because a lot of carriers are closed off at different times of the year for many years. So you might in your head think, yeah, I'm going to take all of these insurances, but in the reality those networks are closed to new providers. So then you have to pivot. So you always want to have a backup plan if the one that you had doesn't go the way that you thought it might. Networks open and close all of the time, but I think it's important to have those backup plans in the event that you have tried to fill out all of these applications only to find out that four out of the five the networks are closed to new.
Not fun.
[00:39:32] Speaker A: Exactly. In my area, our biggest payer, I'm pretty sure they're just not taking new chiropractors. As far as I know, you just can't. The only way I got in is because I was joining an existing practice that was already credentialed and then they maintained my network status when I left. I had an update with them, but they let me stay in and that was the only reason why though. So that's a very good point. Don't move to an area just assuming you'll be able to get into insurance because you might not be able to. That's something that you might want to think about when you're trying to figure out your location.
So Caqh is good to get that set up. So it's just ready to roll then. Medicare though doesn't use Caqh. You just have to do everything directly with Medicare. And Medicare actually is like this magic wizard that sits behind a curtain in Washington DC. You don't ever actually get to see, talk or interact with them ever.
They pay, I am assuming, different private companies to manage Medicare for them across the country. And so depending on what state you are in, you have to find out who the Medicare contractor is for your state. So here in New York we have national government services. So I had to contact ngs to do all of my credentialing. I gotta say, with the advent of technology, it's not easy, but they've definitely made it easier to take care of all that with Medicare. So when I had to, I had to get re credentialed or they had to redo my stuff. When I went off on my own, it wasn't too bad. It was confusing. I had a call a couple times, but a human being got to me and answered my questions. There was even more than once because something was wrong with my thing where the lady called me herself and left me her direct number. And she was really nice. So I'm sure that experience will vary from state to state. But don't be scared of Medicare. Just figure out who manages Medicare in your state and contact them.
I just want to add to the Medicare conversation, there is a little something called railroad Medicare. Have you ever heard of railroad Medicare?
[00:41:40] Speaker B: Oh yeah. Oh yeah. I know the credentialing for railroad is significantly easier than initial Medicare, but you have to be credentialed with initial first.
[00:41:49] Speaker A: Probably why I didn't know who they were until it walked in my office. A very lovely couple that the husband was retired and that's a who, who he had, I don't know. They both had it for some reason. I don't know anyways. And I was like, what? I don't know what this is. And I was so confused. It was a big mess. I had already seen them, probably wrong and. But they were actually kind of helpful because, yeah, you have to get credentials with Medicare first and then you will reach out to railroad Medicare to get set up with them. And it wasn't too bad. They did help me out. They backdated all the stuff. Stuff. So it was fine that I had seen those patients and sent everything in.
[00:42:30] Speaker B: Yeah. Because in order for you to get credentials, you have to have a date of service for a patient to even start that application. Oh, yeah.
[00:42:37] Speaker A: I don't even remember that. So apparently they know everyone has no clue who they are and are trying to figure it out after the fact. So apparently they've tried to accommodate us. So that's good. But I just want to throw that out there because, I mean, I had been in practice like twelve or 13 years and I was like, what do you mean, railroad Medicare? It'll say railroad Medicare on their card and then you're going to be like, oh God, not this. So yeah, anyways, oh, one more thing.
[00:43:03] Speaker B: With Medicare is DME. So a lot of chiropractic offices, they want to do orthotics, back braces, what have you. And it's very different than your typical Medicare credentialing. Like it is a separate Medicare credentialing process when you want to bill and get paid for DME. I can't tell you the number of, I don't want to say issues, challenges that I've experienced with helping docs navigate Medicare DME billing because it is a very separate beast. So having, I would say, a credentialing specialist guide you there is going to be super beneficial.
[00:43:42] Speaker A: I like it.
All right. Is there anything else big you wanted to tackle quickly?
[00:43:48] Speaker B: Um, well, we didn't talk about Ehrs.
[00:43:51] Speaker A: I know. I mean, I think everyone knows what we would suggest.
[00:43:55] Speaker B: What about our listener emails?
[00:43:58] Speaker A: I brought up our email address earlier. Let's revisit. So it's cairocastyrotuch.com. now I'm going to spell that. Chirocast. It's Chiro like you would think. C h I r o.
Cast.
Cast. Like we're a cast of a show, I guess. Cairo cast. At cairo touch.com, you guys can send us messages if you want. That little worksheet that we're going to have, we can get that sent over to you. If you have ideas for future episodes you would like us to do, you could send those in. Also if you have questions, we're going to read all those emails and we're going to try to address your questions. If you send any into us, send us some questions.
[00:44:48] Speaker C: Thank you for joining us on this episode of Chirocast. Insights for modern chiropractors. Brought to you by Chirotouch. Hosted by doctor Stephanie Brown and Danielle Havinas. Produced by Debbie Brooks. Editing from Matthew Dodge. Our theme song, house five, is from Scott W. Brooks. If you enjoyed today's show, don't forget to like, link and subscribe. We appreciate your support and we'll catch you next time.
[00:45:12] Speaker B: Them.
