Starting a medical practice? Consider these permits

Starting your own medical practice typically involves obtaining different types of business permits and healthcare licenses. As with most aspects of opening a private medical practice, the specific requirements will vary depending on the size, specialty, and location of your practice, so it’s always a good idea to check local regulations and consult with an attorney to ensure that you’re fully compliant.

Here are some common permits and licenses that you may need when starting a medical practice.

Your medical license is a fundamental requirement for practicing medicine and providing telehealth services legally in your jurisdiction, so if you haven’t already applied in the state in which you plan to practice (or if your state is not part of the Interstate Medical Licensure Compact), now is the time to do so. 

If you are applying for your license for the first time, or applying for a license from a new state, research the exact licensing requirements, including application fees and renewal intervals. The Federation of State Medical Boards (FSMB) provides a comprehensive list of contact information for each state medical board, as well as resources to make the process easier. It’s important to find out if the state in which you are applying has separate boards for medicine and osteopathy and is a member of the Interstate Medical Licensure Compact. The process can take many months to complete, so the sooner you start, the better. 

Your medical license isn’t the only type of license required to open your practice. You’ll likely need a general business or professional license specific to operating a medical practice from your local government or municipality.

While the primary purpose of your practice is to provide healthcare services, it’s still a business in the eyes of the law. Obtaining a general business license is important for many reasons, including:

Research the specific licensing requirements in your location and comply with all applicable laws and regulations.

Depending on your location, you may need to obtain a permit or license from your state, county, or city health department, or a similar regulatory body. These permits ensure that your medical practice complies with local health and safety regulations. The requirements vary by location, but will likely include the following:

Thoroughly research and consult with an attorney with healthcare experience to make sure you understand the specific requirements set forth by your state or local health department and work with an accountant familiar with healthcare and medical practice management. Engaging with your local health department in the early stages of planning for your medical practice can help streamline the permit application and approval process.

You'll need to register your medical practice with the appropriate tax authorities to fulfill your employment and payroll tax obligations. This means obtaining an employer identification number (EIN).

Applying for an EIN for your practice is a straightforward process. It’s free of charge and can be completed online. Here's are the steps you need to follow to apply for an EIN:

Note that an EIN is used for federal tax purposes, and some states may also require a separate state tax identification number for state tax reporting. Be sure to check with your state's taxing authority to determine what you need for your practice.

Ensure that your medical practice location complies with local zoning regulations. For instance, if the office space for your new practice is not turnkey and you plan to modify the premises, you will likely need to obtain a building permit before doing so. 

A building permit is legal authorization from a local government authority that allows your business to construct, renovate, or make significant changes to buildings or structures. It ensures that your construction project complies with safety codes, zoning regulations, and building standards from the local building department or other relevant agencies. 

Typically, obtaining a building permit involves submitting detailed plans and specifications of the proposed construction, paying fees, and undergoing inspections at various stages of the project to verify compliance. Failing to obtain the required permits or violating its terms can result in penalties, fines, or even halting the construction until compliance is achieved.

Additionally, depending on the speciality and services offered, some medical offices may require special permits for specific reasons such as the delivery or radiation for X-rays, gasses for anesthesia, or other medical services such as medical waste.

If your medical practice is legally registered as "Jane Doe Medical Associates, LLC," but you want to operate and advertise as "Peach Tree Plaza Family Medical Group," you will need to obtain a fictitious name permit.

A fictitious name permit, also known as a doing business as (DBA) permit or trade name permit, is legally required for businesses that operate under a name different from their legal business name. The registration process allows your medical practice to use a fictitious name for operations without changing the name of your legal entity.

Fictitious name permits ensure transparency and protect patients, while also allowing practice owners some latitude in the goals and marketing strategy of the medical practice. They make it clear to the public that you are operating under an alternate name while maintaining the legal identity of the business entity. This is important for many reasons. For instance, patients often object when they receive a bill from an entity with a different name unless they know about it beforehand. 

The requirements for a fictitious name permit may vary depending on your location and jurisdiction. In most cases, applicants must file a DBA registration with the appropriate local or state government agency and pay a registration fee. This process typically involves verifying that the chosen fictitious name is not already in use by another registered business in the area.

It's important to note that a fictitious name permit only allows the business to operate under the alternate name; it does not change the legal structure or liability of the business entity. As such, the legal responsibilities, tax obligations, and any licensing or permits associated with the original business name apply when operating under the fictitious name

The Centers for Medicare and Medicaid Services (CMS) regulates all clinical non-research laboratory testing performed on humans in the US through the Clinical Laboratory Improvement Amendments (CLIA). Unless you are planning to order lab testing from an outside laboratory for every single test, you’ll likely need to obtain CLIA certification or a waiver. While CLIA is a federal program, CMS relies on state agencies to process CLIA applications and renewals and to conduct oversight and maintain CLIA laboratories’ certification records, so work with the appropriate agency to ensure compliance.

CLIA certification and CLIA waiver are different categories under the CLIA program, and depending on the laboratory services your practice offers, you will need to obtain one or the other. 

A CLIA certificate is required for laboratories that perform moderate- and high-complexity testing or conduct a wide range of complex tests, including advanced diagnostic tests and tests that require specialized equipment and technical expertise. To obtain a CLIA certificate, the lab must meet specific quality control and proficiency testing requirements, demonstrate proper training and competency of personnel, and adhere to stringent CMS standards. A laboratory with a CLIA certificate is subject to regular inspections to ensure ongoing compliance with CLIA regulations.

A CLIA waiver is granted to laboratories that perform simple, waived tests. Waived tests generally have a low risk of error and can be performed with minimal chances of producing incorrect results, so that there is a low risk of harm to patients if performed incorrectly. 

Examples of waived tests include certain rapid diagnostic tests, such as influenza or strep, urine dipsticks, and other simple point-of-care tests. Laboratories with a CLIA waiver are subject to fewer regulatory requirements, yet they still must comply with basic quality control and record-keeping guidelines to maintain the waiver status.

Carefully assess the types of laboratory tests you intend to perform and determine whether you need a CLIA certificate or can operate under a CLIA waiver. The complexity of the tests offered will dictate the appropriate CLIA category and the associated regulatory requirements. Obtaining the correct certification ensures that the laboratory meets the necessary standards for quality, accuracy, and patient safety in the testing processes.

Occupational Safety and Health Administration (OSHA) requirements apply to many healthcare employers. These OSHA regulations ensure a safe and healthy working environment for employees and patients. Your practice should require designated staff members and providers to participate in recognized OSHA courses for certification. Additionally, many states require providers to complete OSHA, fire safety, and other continuing education courses to satisfy medical or nursing licensing requirements.

OSHA requirements may vary depending on the speciality, size, and services offered by your medical practice. Here are some key OSHA requirements:

Review OSHA guidelines, seek professional advice if necessary, and ensure ongoing compliance with new or changing regulations to promote a safe and healthy workplace environment for your team. To streamline the process and ensure compliance, designate an individual on the team who is in charge of maintaining these records. 

Obtaining proper permits for your medical practice requires considerable time and effort, but it’s absolutely essential to operating a safe medical practice. By complying with all licensing and permit requirements, you protect your patients from harm and protect your practice from liability and malfeasance.

While it may take time to complete all the permitting requirements and may even delay the opening of your practices, it’s important to demonstrate that you take your legal and ethical obligations seriously and are committed to safeguarding your patients' health and building trust within the community.