PA Incorporation

[Devildog]

WA state.

 

I don't know about CA...but there were some PA's that used to lecture at Stanford that owned/ran their own clinics.

 

I just did as many solo MDs had done...

 

1. Wrote the Company mission/intent, By-Laws/rules, job descriptions, etc...
   
2. Wrote the Contracts for the Docs (hired one...looking for others!)
   
3. Hired a provider (Me)
   
4. Then Formed a Limited Liability Corporation= $500 and 24hrs (PrimeCare PLLC)
   

PrimeCare PLLC salary for Members (Providers/Owners): 60% of reimbursment! (35% to SP doc and 5% to company)

 

 

PrimeCare PLLC benefit package for Members (Providers/Owners):

1. A company vehicle, licensing, fuel, vehicle insurance, vehicle maintenance.
   
2. Cellular phone and data service. ($200/month)
   
3. Motion Tablet PC with EMR, a desktop PC with winfax.
   
4. Internet service allotment ($40/month)
   
5. Paid Malpractice, disability, Health care premium, licensing fees
   
6. CME ($2000/year)
   
7. Medical Books, journals and equipment ($500/2years)
   
8. 401k
   

8 months in operation and doing ok;)

 

DocNusum

 

Well done! I admire you for doing this. I wish a grew a pair to do it

[Guest gerimed]

Can anyone verify the Medicare policy that allows a PA to own 99% of an LLC with a non-medical person owning 1%? I have been told this by the AAPA, but have had trouble getting this in writing.

[JasonR]

I love reviving these dead threads...

Have the independent contractors here seen this:

http://www.aapa.org/advocacy-and-practice-resources/practice-resources/employment/1050

Its the 20 things the IRS looks for to determine if a worker is really an independent contractor or not.

 

And here is a form with similar questions that can be submitted to the IRS for official determination of your employment status:

http://www.irs.gov/pub/irs-pdf/fss8.pdf

 

Is it even possible to be an independent contractor, to a corporation you own, that contracts you out to places like emergency departments?

[brookspa]

rgmullis: re: GA PA practice ownership: CSBME 36--3-.02 andOCGA 43-1-19 and 43-34-37. This should make it clear that it can be done....sorta, kindalike , maybe.

[brookspa]

rgmullis: sorry meant to say 360-3-.02

[Contrarian]

Well done! I admire you for doing this. I wish a grew a pair to do it

 

Devildog...

 

It didn't work.... since:

 

Medicare reimbursement bites...

All the billing had to be routed through the physician

I didn't calculate the level of "greed" of the Physicians

Once I got started and rolling (about 500 patients)... he started demanding 12k a month....!!!

When I refused... he "black-balled" me to his "collegues" (basically all community physicians that would listen. MD v/s PA.... MD wins...!!!)

I put everything on the "backburner" and sought "traditional" employment to pay the bills while I continued to search for another MD employee.

 

At this time, I was offered and accepted 2 well paying positions in urgent care.... even went through orientation and credentialing for these jobs then found that in this state there is a malpractice insurer that holds about 80% of the market and when they contacted my former "sponsoring physician"... he made "vague/cryptic but negative remarks" so this insurance company declined insuring me for a yr... which basically eliminated me from working for ~80% of the practices in this state for a yr...:mad::mad::mad:

 

So... I went to Iraq for 3 months ($850/day x 90 days)... came home for 3 months then went to Afghanistan for 6 months ($750/day it was safe then).

I made $211k that yr... for 9 months of work and only saw ~ 40 patients.:cool:

 

The money was so good that I took another overseas yr long job in the Darfur & southern regions of Sudan (much safer) for $196k.

 

Finally "Wifee" said the $$$ was good but "no-more leaving".... so I started working in the community again... but for no less than $90k. I've been back since Q3 2007... but starting to "get the itch to travel".....;)

 

I still have the PLLC and we continually improve out business plan and look for opportunities to to break out of the traditional practice arrangement... but gotta pay them bills.

 

Contrarian

[JasonR]

Contrarian,

You had to send all the billing through the physician? Why? to get the 100% reimbursement?

Also, was this the same SP that was getting 35% of the profits?

[Contrarian]

Contrarian,

You had to send all the billing through the physician? Why? To get the 100% reimbursement? [No... because "Third party payors" (insurance companies) generally DO NOT reimburse directly to PAs... but do reimburse directly to NPs and Physicians. So the 3 NPs that worked with that doc at the same time I did, got reimbursed directly then paid him. I had to let him bill then wait to get paid... I got shafted!!! There are a few companies that do reimburse directly but they are few and far. Funny, I just cashed a $75 reimburesment check from one such company last week. This check was for services I rendered back in 2005. ]

Also, was this the same SP that was getting 35% of the profits? [Yes initially...then after I started seeing lots of "homebound" patients and built up my reputaition/patient panel he demanded a larger cut. I discussed this with the NPs that were working with him and found that was his Modus operandi... it was a simple "bait and switch" game. All of the NPs quit working with him, as did I, and I hear that once his reputation got around, he has been unable to get any new Mid-levels to work with him, and the occassional new grads that do... learn really quick and get away from him.]

 

Good Luck...!!!

 

Contrarian

[JasonR]

Thanks Contrarian.

 

New question: What is this nebulous "registry" that all the contract agencies have access to for job postings? It is a very mysterious thing, that no one likes to talk about. Reminds me of the MLS for real estate agents. So what is it, where is it, and how do you get access to it? Anyone know anything about this enigma?

[jmj11]

If this has been covered before, forgive me for asking again.

 

What has been your (anyone) experience with contracting with insurance companies as a PA-practice owner? I'm looking into starting my own clinic again. The last time I did, I discussed it with some of our local carriers. Because it would be a specialty clinic, I met a lot of opposition. Premera Bluecross's medical director (an MD) told me that they would not do business with a PA-owned clinic, even if they employed an MD. I explained that this was a very poor decision considering that I could offer superior care at a lower cost.

[burnpac]

I live in California and have had a PA corporation (there is a specific entity in CA) since 2005. My initial reason for setting it up was to start a staffing company, but now it is just me. I contract at a couple of different practices, contract with them by the hour, and draw a salary from my corporation. This is a much different thing that setting up a practice corporation to own a practice, and the rules in every state are very different. You may still not be able to be considered an "independent contractor" in the eyes of the IRS if you are not careful of the rules, which can be found on the IRS website. My corporation was set up by an attorney very familiar with PAs, and I'm in a better position as I contract with more than one practice. I pay all my payroll taxes from the corporation. It has been great because I have my own retirement plan (and can make large year-end contributions), and can pay a lot of business expenses through my corporation. I would recommend it to every PA, but with the caveat that it is potentially hazardous to do without counsel familiar with PAs and the laws in your state. All the downside of being an independent contractor, however, is on the side of the practice that you work for, as long as you pay your taxes.

[johnjppa]

Hey Jeff, anyone can incorperate, even PA's, the problem sometimes is if you work for a practice and there is really no reason your not employed. The IRS will hold them (YOUR EMPLOYER) responsible for any uncollected taxes from you. Or at least their accountants will tell them this. However,for example in my case I own a Neuro-interventional/Diagnostic C corp and travel exclusively, I own my own plane, employee other people and I not only provide services but equipment, supplies and other technical staf,f that their practice wouldn't otherwise have. So it is clear that I am a company that provides a service the practices I go to don't normally provide. At each office I have a supervising physician, whom still bills for my services and supervises some component of my service, the PA portion and I supervise another portion, the PhD, Neurophysiologist portion.

I have already been round and round with the state Medical Boards about this everytime" Joe neurologist" a legal expert on PA scope of practice, they always are, complains about what I can and can't do. Fortunately I have the money and legal staff to squash this each and everytime. And by now the Boards are tired of seeing me and my team.

So I guess if it's a real convuluted business set up like mine where nobody can make heads or tails of it, you should be fine. But the IRS is looking at this practice very closely, so if it's not clear cut travel and service up and above provider services(no equipment etc..) then you better be careful.

[JasonR]

Burnpac, what happened with the staffing company idea? I've thought of keeping it small and getting friends (nurses, pa, pt, etc) to work travel jobs for my company. Anything go wrong or did you just not pursue it?

[burnpac]

Burnpac, what happened with the staffing company idea? I've thought of keeping it small and getting friends (nurses, pa, pt, etc) to work travel jobs for my company. Anything go wrong or did you just not pursue it?

 

Dear Jason,

 

Sorry for the slow response. Have been up to my ears in work and travel the past couple of weeks.

 

Nothing went wrong, it was a personal decision. I had about ten full and part time PAs working for me staffing ERs and Urgent cares. It was very lucrative, but extremely stressful and time consuming. I like supervising folks, as long as they are just like me. But, it became hard struggling to fill shifts with last minute call offs, etc., and I went through some personal challenges at the end of 2008 that made me rethink my life goals. My partner also moved. I kept my corporation (now an S-Corp), and I'm the sole employee. I draw a salary from the corporation, and I work for two to three practices, contracting between them and my corporation by the hour or by the month. I have my own retirement plan, do my payroll and taxes through Paycycle online, and it works great. It is the only way to work like an "independent contractor" in California. I like having control of retirement, and the ability to shelter business expenses.

[JasonR]

For all the small business owners out there: http://www.forbes.com/2010/06/09/tax-increase-congress-hedge-funds-personal-finance-s-corp-payoll-taxes.html

 

Professional S-corps, such as a PA who hires him/herself out to multiple companies and provides a medical service will no longer be able to avoid self-employment taxes on the distribution portion of their S-corp profit. It will all be considered W-2 income to the PA and therefore have medicare and self-employment tax levied. Plus the 0.9% Medicare surtax on all income over 250K for couples and 200k for individuals, that comes with Obamacare. Hard times ahead for the incorporated professional.

[burnpac]

For all the small business owners out there: http://www.forbes.com/2010/06/09/tax-increase-congress-hedge-funds-personal-finance-s-corp-payoll-taxes.html

 

Professional S-corps, such as a PA who hires him/herself out to multiple companies and provides a medical service will no longer be able to avoid self-employment taxes on the distribution portion of their S-corp profit. It will all be considered W-2 income to the PA and therefore have medicare and self-employment tax levied. Plus the 0.9% Medicare surtax on all income over 250K for couples and 200k for individuals, that comes with Obamacare. Hard times ahead for the incorporated professional.

 

Jason,

 

Thanks for sharing this. I forwarded it to my accountant. The good news is that I pay myself enough from my corporation that there is not a lot of "distributions" at the end of the year, and I exceed the caps already on some of the employee taxes. And, what I did this year (2009) when I had a significant net is that I made a large employer year end contribution to my 401 (k), which defers the profit to later years.

[Marilyn1122]

So... I went to Iraq for 3 months ($850/day x 90 days)... came home for 3 months then went to Afghanistan for 6 months ($750/day it was safe then).

I made $211k that yr... for 9 months of work and only saw ~ 40 patients.:cool:

 

The money was so good that I took another overseas yr long job in the Darfur & southern regions of Sudan (much safer) for $196k.

 

 

That's great money. How did you get those over-sea PA jobs? Are you in the military?

[jmj11]

I live in Florida, where the law dictates that a PA can own up to 99% of a medical practice, and the remaining 1% can be owned by anyone else, whether it be a physician or not.

 

Eric.

 

It is the same here in Washington state. I did meet with a business attorney about this very thing. My present SPs were arguing that it is illegal for a PA to own a practice. The attorney pointed to Washington state laws for medical LLC and proved that there is nothing that would inhibit a PA from owning a practice as long as 1% is owned by someone else, and that someone else can be their spouse.

 

The confusion is, as the attorney pointed out, is that many LLCs and Corps write into their own corporate bylaws that all owners must be an MD (or Chiropractor, etc.) but this is not a state law requirement.

[Contrarian]

That's great money. How did you get those over-sea PA jobs? Are you in the military?

I networked with former military buddies who were security contractors and then applied to/recommended to the big five security firms.

[IRISH BULLDOG]

Abby

Is this website working as I would like to get some info on independent contractor tax/ options...

I was unable to sign in ir log in ???

[JasonR]

Abby

Is this website working as I would like to get some info on independent contractor tax/ options...

I was unable to sign in ir log in ???

 

Um, I dont know who Abby is, nor do I know why you say you can't log-in when you are clearly logged in. How about just posting your question for us to look at?

[PASun]

For all the small business owners out there: The Big Tax Increase Facing Small Business - Forbes.com

 

Professional S-corps, such as a PA who hires him/herself out to multiple companies and provides a medical service will no longer be able to avoid self-employment taxes on the distribution portion of their S-corp profit. It will all be considered W-2 income to the PA and therefore have medicare and self-employment tax levied. Plus the 0.9% Medicare surtax on all income over 250K for couples and 200k for individuals, that comes with Obamacare. Hard times ahead for the incorporated professional.

 

Tax Extenders Bill Is Dead But Not For Harry Reid’s Lack Of Effort - Great Speculations - Buys, holds, and hopes - Forbes

 

Jun. 25 2010 - 8:56 am | 300 views | 0 recommendations | 0 comments

Tax Extenders Bill Is Dead But Not For Harry Reid’s Lack Of Effort

 

Posted by Robert Green

Three strikes, and the tax extenders bill is out: The Senate failed Thursday night for the third and final time in its efforts to pass the American Jobs and Closing Tax Loopholes Act (HR 4213).

Sen. Harry Reid (D-Nev.) won’t give up yet. He has said he will try to float a stripped down tax hike bill, and I presume it will include the repeal of carried interest. Reid will probably fail again, since his own party’s Sen. Ben Nelson (D-Neb.) has joined the Republican opposition against this tax hike bill. Republicans will probably block any tax hike. Sen. Nelson specifically said he does not want the carried interest repeal on real estate partnerships, which are a big factor in every state, unlike like hedge funds, private equity and venture capital funds concentrated in New York, California, Illinois, Massachusetts and other larger states. (Sen. Nelson is winning back stripes after his infamous Cornhusker-kickback health care deal.)

Repealing carried interest is losing appeal as more and more leaders oppose its consequences, unintended or otherwise. It’s a growth killer in this weak economy and it’s un-American to tax small businesses with ordinary income after their lifetime of hard work to build up their business with risk capital. These entrepreneurs, including investment managers, deserve capital gains when appropriate. And remember, often times carried interest is ordinary income too.

President Obama’s senior advisor David Axelrod is a premier branding and re-branding expert; it was his profession before joining the Obama campaign. This Congress has taken re-branding to heart too. It’s the ugly side of politics, turning garbage into gold with the right name and campaign to fool the voting public. Did this happen with HR 4213? It went from being labeled a “tax extenders” bill to a “tax hike” bill. Tax extenders implies extending tax breaks and credits to spur the economy. Then the bill was titled “Closing Tax Loopholes.” Selling a business for a capital gain is not a loophole.

Financial regulation reform is now mostly about debating the Volcker Rule and derivatives, and the carried-interest tax hike on investment partnerships is not part of it. It was part of HR 4213 only and that is now dead.

Looks like the Bill failed. Any more hoops to jump thru??

[Gmurphy]

I hope someone didn't post this already, but I am on the state board in Maine and there are currently several PA owned practices where the PA employs their supervising doc. The state, due to the actions of one or two knucklehead PAs (who did NOT own practices), is reexamining this relationship and it is a significant source of angst for those practice owners.

[PASun]

WA state.

 

 

I just did as many solo MDs had done...

 

 

1. Wrote the Company mission/intent, By-Laws/rules, job descriptions, etc...
   
2. Wrote the Contracts for the Docs (hired one...looking for others!)
   
3. Hired a provider (Me)
   
4. Then Formed a Limited Liability Corporation= $500 and 24hrs (PrimeCare PLLC)
   

PrimeCare PLLC salary for Members (Providers/Owners): 60% of reimbursment! (35% to SP doc and 5% to company)

 

PrimeCare PLLC benefit package for Members (Providers/Owners):

 

1. A company vehicle, licensing, fuel, vehicle insurance, vehicle maintenance.
   
2. Cellular phone and data service. ($200/month)
   
3. Motion Tablet PC with EMR, a desktop PC with winfax.
   
4. Internet service allotment ($40/month)
   
5. Paid Malpractice, disability, Health care premium, licensing fees
   
6. CME ($2000/year)
   
7. Medical Books, journals and equipment ($500/2years)
   
8. 401k
   

8 months in operation and doing ok;)

 

DocNusum

 

Nice plan...anyone know about Maryland?? Or Delaware??