When you're ready to grow, the operators are already here.

A de novo outpatient clinic has a checklist most owners only run once: entity setup, NPI and Medicare enrollment, payer credentialing, fee-schedule decisions, EMR selection, and the billing workflows that have to work on day one. We've stood up clinics before, so you're not improvising. We map the launch, sequence the credentialing so you can bill from the first visit, and set the revenue cycle up to run clean from the start.

• Entity, NPI, and Medicare enrollment, sequenced so nothing waits on nothing.
• Payer credentialing timed to your open date.
• Fee-schedule and EMR decisions made with someone who has lived the consequences.
• Billing workflows configured before the first patient, not after the first denial.

Scoped per project — quote-gated, no published range.

For the current performance period, MIPS sits at a 75-point threshold, and falling short carries up to a -9% Medicare payment adjustment (APTA / CMS Quality Payment Program). For an outpatient therapy practice, that's real money on every Medicare claim. We don't just explain MIPS — we build the measure set you can actually report on, set up the data capture inside your workflow, and track your projected score through the year so the penalty never surprises you.

• A measure set chosen for outpatient therapy, not a generic provider template.
• Data capture built into your existing workflow.
• Projected-score tracking through the period, so you adjust in time.
• Promoting Interoperability and improvement-activity requirements mapped to what you actually do.

The rate a payer pays you is in a contract — and contracts can be renegotiated. Most independent owners never open that conversation, because they don't know where they stand, don't have the data to make the case, and don't have the time. This is a named service we run, not a footnote on a billing agreement: we pull your fee schedules apart, benchmark your rates against what the work is worth, find the contracts where you're underpaid, and build the case to bring to the payer. It's run by operators who have negotiated payer contracts across a large, multi-state book — so you're not walking in cold.

• Fee-schedule analysis — every CPT line, every payer, where you're underpaid.
• Contract review — the terms most owners never read, including escalators and silent renewals.
• The negotiation case — built on your data, made the way payers actually respond to.
• Ongoing contract management — so a renewal isn't a quiet rate cut you find out about later.

Rate lifts are possible when the case is real — the strategy work in this niche points to single- to low-double-digit improvements where contracts are genuinely underpriced (Next-Wave Niches strategy brief, 2025). We don't promise a number we haven't earned on your contracts; we show you what your data supports.

A second location, a new state, or a billing volume your front desk can't absorb — expansion is where a working practice quietly starts leaking. We've scaled therapy operations across state lines, so we know where it breaks: credentialing that lags the open date, payer panels that differ by state, and A/R that grows faster than the team. We plan the expansion so the operation grows with you instead of cracking under you.

• Multi-state credentialing sequenced to your timeline (ties to our credentialing service).
• Per-state payer, direct-access, and workers' comp differences handled, not discovered.
• Billing capacity that scales with volume instead of capping it.
• A/R and denial benchmarking across locations, so a weak clinic shows up early.