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Independent CRNA Practice Startup Checklist

A checklist for CRNAs starting a group or going 1099: entity, NPI, Medicare enrollment, payer contracts, facility agreements, malpractice and billing.

For CRNAs forming a group or working as independent contractors. Requirements vary by state and payer; use this as a planning list and get legal, tax and billing advice.

Before you start

  • Check your state's scope of practice and whether it has opted out of Medicare physician supervision.
  • Talk to the facilities you'll cover: volume, payer mix, stipend needs and contract length.
  • Model cash flow: enrollment can take months before payments start.

Business setup

  • Form your entity (often a PLLC or professional corporation) and get an EIN.
  • Open a business bank account.
  • Get a Type 2 (organizational) NPI for the group; keep your Type 1 individual NPI current.
  • Set up accounting and payroll.

Licensing and credentials

  • Active RN and APRN licenses in every state you'll practice.
  • NBCRNA certification current (note MAC requirements).
  • DEA registration where required, one per state of practice.
  • CAQH Provider Data Portal profile complete and attested.

Payer enrollment

  • Enroll the group in Medicare (CMS-855B) and each CRNA (CMS-855I, including reassignment of benefits).
  • Enroll in your state Medicaid program and managed care plans.
  • Apply for commercial contracts early; credentialing can take 90 to 180 days.
  • Set up electronic funds transfer and remittance with each payer.

Contracts and insurance

  • Facility anesthesia services agreement: coverage, call, exclusivity, stipend, term and termination.
  • Malpractice: occurrence vs claims-made, limits, tail coverage.
  • Business, cyber and workers' comp insurance.
  • Contractor agreements for any 1099 CRNAs, reviewed by a lawyer.

Billing and getting paid

  • Choose who bills: in-house or a specialist anesthesia billing company.
  • Sign a business associate agreement (HIPAA) with your biller.
  • Confirm anesthesia time capture, modifiers (QZ, QK, QX) and documentation standards.
  • Agree on monthly reporting: net collection rate, denials, days in A/R.
  • Review your first 90 days of claims closely.

Ongoing

  • Track license, certification and DEA renewal dates.
  • Revalidate Medicare enrollment when due.
  • Review payer contracts yearly.

…the full PDF continues.

For practice owners

Run a CRNA group?

The group's billing decides how much of every case actually gets paid. Our partner Titrate Revenue, a US anesthesia billing company, offers a free billing review for independent CRNA and anesthesia groups.

Get a free billing review

Titrate Revenue is a partner of Everything CRNA. Nelson is a founding adviser.