Starting a Multi-State Telemedicine Practice

[PA-C]

I’m getting tired of working for other people/being tied down to one physical location and have been thinking about starting my own telemedicine practice. I already happen to be licensed in a few states due to moving /thinking of moving to different areas over the years and would like to be able to care for patients in all the states in which I hold licensure. Does anyone know if I would have to incorporate the practice in each of those states? Or is it ok/legal to form the PLLC in State A and accept patients from State X, Y and Z so long as I hold a PA license in each of those other states?

[gsoames]

For tax purposes, you must register your business with the SOS of each state in which you plan to do business.  You must also pay taxes specific to the income generated from that state.  

While doing telemedicine in all the states you are medically licensed in sounds good in theory, you must be sure to register and pay all fees for each of the states you generate revenue from.

Many states have a revenue threshold before you have to actually register.  If you do not cross this threshold, you are not required to pay taxes in that particular state (you would still need to pay taxes in the state where you are located).

What this means is you may build your practice, and when you are close to passing that threshold in a particular state, you can then file for a foreign LLC in that state.  

https://kkoslawyers.com/when-do-i-need-to-register-my-business-in-another-state/

Many states now have telemedicine business licenses as well.  You will need to secure the business license in those states that have them before practicing there.  For example, here is Alaska's telemed business registry:

https://www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/TelemedicineBusinessRegistry

Opening a multistate telemedicine practice is not as easy as you might think.  You basically have to file taxes in every state where you now see patients.  If you hire employees, you now have a full time job just doing payroll and calculating withholding for each state.

[PA-C]

On 7/25/2022 at 3:15 PM, gsoames said:

For tax purposes, you must register your business with the SOS of each state in which you plan to do business.  You must also pay taxes specific to the income generated from that state.  

While doing telemedicine in all the states you are medically licensed in sounds good in theory, you must be sure to register and pay all fees for each of the states you generate revenue from.

Many states have a revenue threshold before you have to actually register.  If you do not cross this threshold, you are not required to pay taxes in that particular state (you would still need to pay taxes in the state where you are located).

What this means is you may build your practice, and when you are close to passing that threshold in a particular state, you can then file for a foreign LLC in that state.  

https://kkoslawyers.com/when-do-i-need-to-register-my-business-in-another-state/

Many states now have telemedicine business licenses as well.  You will need to secure the business license in those states that have them before practicing there.  For example, here is Alaska's telemed business registry:

https://www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/TelemedicineBusinessRegistry

Opening a multistate telemedicine practice is not as easy as you might think.  You basically have to file taxes in every state where you now see patients.  If you hire employees, you now have a full time job just doing payroll and calculating withholding for each state.

Thank you for the very thorough explanation! I can definitely see how one could “go down the rabbit hole,” so to speak, with this type of idea. I’ll need to do a lot more research to get myself up and running and see what’s sustainable and realistic.

I must have missed the notification that you responded to this post - sorry for the delayed response.