Start a Private Neurology Practice

1. 1

   Confirm your case mix before signing a lease

   The economics of an independent neurology practice depend on procedural volume, not office visits alone. Map your expected referrals by condition (epilepsy, neuropathy, movement disorders, headache, MS) and estimate how many EEGs, EMGs, sleep studies, botulinum injection visits, and infusions that translates to per month. If the visit-only volume cannot cover fixed costs, the procedural and infusion lines are what make ownership work, so plan them from day one.

2. 2

   Get licensed, insured, and credentialed

   You need an active state medical license, board certification or eligibility in neurology, DEA registration, malpractice coverage, and your own NPI and Tax ID for the practice entity. Payer credentialing and in-network contracting typically run 90 to 180 days per payer, so start during build-out, not after opening. Nothing gets paid until the practice is enrolled with Medicare and the commercial plans your referral base uses.

3. 3

   Decide which procedural lines you run in-house

   EEG and EMG interpretation generate substantially more work RVUs per unit of time than standard visits, and an in-office IV infusion suite for migraine and MS is one of the highest-margin lines in the specialty. Each line carries its own equipment, staffing, supervision, and coding requirements. Choose the two or three you can staff and bill correctly first, then add lines as volume proves out rather than buying every machine on opening day.

4. 4

   Build a revenue cycle that speaks procedure and infusion

   Neurology billing is not general office billing. Procedure codes, infusion drug acquisition and buy-and-bill economics, prior authorization for high-cost MS infusibles, and correct documentation for EEG/EMG interpretation all require staff or a billing partner who knows the specialty. Underbilling procedures or mishandling infusion drug cost is the fastest way to erase the margin that justified owning the practice. Pick an EHR and billing setup built for specialty procedural work.

5. 5

   Handle the buy-and-bill and drug-cost risk of infusion

   An infusion suite is lucrative but ties up cash: you often purchase expensive biologic drugs up front and bill the payer after administration, so a single denied claim can cost tens of thousands of dollars. Set clear prior-authorization and benefits-verification steps before any infusion, negotiate drug acquisition through a specialty distributor or group purchasing arrangement, and keep working capital for the lag between drug purchase and reimbursement. Treat infusion as a small pharmacy business inside the practice.

6. 6

   Staff lean and protect physician time

   Hire the smallest team that lets you spend your hours on billable interpretation and procedures: a practice manager, a biller or billing partner, EEG/EMG technologists, infusion nursing, and front-desk and prior-auth support. The scarcest resource is your reading and procedural time, so build the schedule so technicians and nurses handle setup and administration while you interpret and treat. Measure the practice on procedural throughput and clean-claim rate, not visit count alone.

7. 7

   Know the referral and self-referral guardrails

   Owning diagnostic and infusion services you order for your own patients sits inside federal Stark and Anti-Kickback law, which has specific rules and exceptions for in-office ancillary services. This is not optional homework; structure the entity, the equipment ownership, and any physician-group arrangements with healthcare counsel before you bill. This card explains the business, not the law, so get specialized legal and compliance advice for your state and your service lines.

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Best for: Board-certified or board-eligible neurologists who want to own their procedural and infusion revenue rather than draw a salary against it

Not for: This is not for someone without a medical license or for a neurologist who wants a pure office-visit lifestyle practice with no procedural or infusion operations. It is capital-, credentialing-, and compliance-heavy, and the margin depends on running the procedural and infusion lines well.