Starting Your Practice: Coding & Compliance Billing

Table of Contents

1. Introduction
2. First – Create a Menu
3. What About Billing the Work?
4. Creating a Lean, Mean Compliance Plan

Introduction

Congratulations—launching a practice is such an exciting milestone as you begin shaping the future of your patient experience. It is easy to enjoy decisions like selecting paint colors and exam tables that make your space feel welcoming and familiar for patients. But alongside those creative choices, there are also the less exciting but essential responsibilities. Addressing those early on will help set a foundation for financial stability and protect your practice from compliance risks that could otherwise open the door to unwanted scrutiny.

First – Create a Menu

I know your practice isn’t serving fine dining, but you do have a menu of services. It is important to review that menu to confirm each service is billable, reimbursable, and coded correctly to reflect the care you provide.

Your list doesn’t need to be elaborate, just a simple spreadsheet will do, much like the sample shown here. It’s a good idea to have a coder, auditor, or consultant review the list for accuracy. They can perform a comparative analysis, checking that each code matches the service description and that your charge amounts line up appropriately with Medicare reimbursement.

As you build your menu of services, you’ll notice we’ve included not only the billable CPT code but also the average reimbursement amount and the charge amount. Remember, your practice will need to establish its own charge amounts, which are typically set at about 150 to 200 percent of the Medicare fee schedule. This information is important to enter into your practice management system and will also be essential when you start projecting monthly revenue.

Resource: CMS National Fee Schedule Look Up

What About Billing the Work?

Hiring the right clinical support team often comes naturally, but the billing side of the business can feel less straightforward. Billing may not be rocket science, but it does require a specialized skill set. Just as you wouldn’t ask a rocket scientist to groom your dog, you shouldn’t hand billing over to someone who doesn’t understand its complexities.

For some practices, it makes sense to start by outsourcing billing with the goal of bringing it in-house once operations are running lean and refined. Others may choose to outsource for the long haul. Either way, protect your practice by maintaining your own billing software.

Here’s why: if you lease a platform through a billing company or use their proprietary system, you’re tying your data—and your revenue stream—to them. Separating later can be messy, costly, and sometimes devastating. We’ve seen practices lose months of claims history, encounter interruptions in cash flow, or have to rebuild patient and payer data from scratch just to move on. In some cases, access to your own records may even be delayed or restricted until contractual issues are resolved.

A reputable billing company will perform services through your own billing system, provided it’s one of the mainstream platforms. That way, your data stays yours, your reporting remains transparent, and if you ever decide to make a change, the transition is far smoother.

Creating a Lean, Mean Compliance Plan

Every practice, no matter the size, needs a compliance plan. Think of it as your guardrail system, it doesn’t just protect you from regulatory pitfalls, it also creates structure for how your team handles documentation, billing, and daily operations.

Starting out, your compliance plan doesn’t need to be overwhelming. Begin with the basics: policies on documentation, billing oversight, staff education, and a way to report and correct errors. As your practice grows, your plan should grow with it, layering in more formal processes and safeguards.

Here’s a simple starter checklist for a new practice:

• Written policies for documentation and billing (even a few pages to start)
• A designated compliance contact (this may be the physician-owner or practice manager at first)
• Training staff on the basics of coding, billing, and documentation expectations
• Clear process for reporting errors or compliance concerns
• Routine spot checks of claims before submission
• Review of write-offs and adjustments at least monthly
• A plan for correcting errors and re-educating staff when needed

That’s it. Lean, mean, and effective. This framework gives you a starting point, and as your practice grows, you’ll add more structure and sophistication. What matters most is that you don’t delay—it’s much harder to bolt compliance on the practice later than to build it in from the beginning.

Resource: OIG: Complete Compliance Plan Resource Guidance

Launching a practice is equal parts vision and preparation- and come on a lot of fun too watching that vision come to life. Knowing that coding and billing can either serve as the lifeline of your revenue or become the source of fraud and abuse means the choices you make now will shape the future of your business just as much as the care you deliver.

The good news? You don’t need to have it all figured out on day one. Start with a clear service menu, protect your revenue with the right billing structure, and put a lean compliance plan in place. From there, you can refine, expand, and grow as your practice does.

The practices that thrive aren’t necessarily the ones that are the fanciest or fastest out of the gate, they’re the ones that took time to build a strong foundation.

So, as you plan the color of your waiting room walls, also plan the systems that will keep your practice financially strong and compliant. Your future self, and your patients, will thank you.

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