New job onboarding checklist

Payer enrollment takes 90 to 180 days and hospital privileging takes 60 to 120, so both start the week the contract is signed.

• CAQH profile complete and attested, with the new practice location and Type 2 NPI. One profile gates every payer.
• PECOS reassignment filed. Medicare allows 30 days of retroactive billing from the receipt date, so a late filing costs real money.
• Commercial payers filed in parallel, at least the top 6 by local volume. Ask the practice for its payer mix before choosing the order.
• Hospital privileges requested for the full scope on the first application: spine, general orthopaedic trauma call, and any ASC. Adding a privilege later is a second committee cycle.
• 24-month case log pulled from the prior EMR before access ends. Privileging committees ask for it, and you will lose access after you leave.
• DEA and state license addresses updated within 30 days of the move.
• Malpractice bound for day 1, with the prior policy's tail confirmed in writing.

A spine surgeon with no referral base does 4 to 6 cases a month; one with 30 active referring providers does 20.

• Google Business profile claimed, verified, and pointing to a page that names you, your training, and your subspecialty.
• Doximity, Healthgrades, and the state medical society listing updated the same week.
• A referral list of every primary care, chiropractor, physical therapist, pain physician, urgent care, and imaging center within 30 miles, with a name and a direct number for each.
• A one-page referral sheet: what you treat, what you want sent, how to send it, and a phone number that a human answers.
• 10 in-person visits to referring offices in the first 60 days. Bring the sheet.
• One measurable: new patient referrals per week, tracked from week 1.

Fix it before the first clinic day.

• The intake form captures payer at the door so Medicare, commercial, workers' compensation, and cash route correctly without a phone call.
• Outside imaging requested at scheduling. A new spine visit without the MRI is a wasted slot for both parties.
• Prior records, prior surgeon, and prior injections listed on the form, with dates.
• Patient-reported outcomes collected at intake: ODI or NDI, VAS back and leg, and PROMIS-PF. This is your baseline for every outcome you will ever report.
• Scheduling templates built: new spine 30 minutes, return 15, post-op 15, with imaging review time blocked in.
• Cash prices set and written down for the self-pay visit and the MRI review. Quote them by payer class, since a single advertised price to all patients creates a Medicare problem.

Decide how notes get written before the first patient, because the habit set in week 1 lasts years.

• Scribe method chosen: AI scribe, human scribe, or self-typed. Measure minutes per note in week 2 and again in week 8.
• Note templates for the 6 highest-volume visit types: new lumbar, new cervical, return with imaging, injection follow-up, pre-op, post-op.
• MDM and level-of-service logic documented once, so a level 4 visit is coded as a level 4.
• Operative note template with the elements the coder needs: levels, approach, implants, instrumentation, neuromonitoring, and estimated blood loss.
• EMR access confirmed for every site you will operate at, plus the imaging viewer and the PACS login.
• Turnaround target set: notes signed within 24 hours, operative notes the same day.

The data you keep yourself is the only data you will own when you leave.

• A personal case log with date, procedure, CPT, levels, approach, implant vendor, facility, and payer. Aggregates only, no patient identifiers.
• Outcomes captured at 6 weeks, 3 months, and 1 year using the same instruments as intake.
• Complications logged in real time: reoperation, infection, dural tear, hardware failure, readmission within 30 days.
• Monthly wRVU total pulled from the billing office. This number sets your next contract.
• Preference cards written for every procedure before the first case at each facility, and reviewed with the scrub team.
• Implant vendor reps identified for each system, with a direct number for add-on cases.

Track both yourself from month 1 so you see a problem before the first-year guarantee runs out.

• Who codes your notes, and whether you review the codes before submission.
• Collection rate by payer for the last 12 months, and the denial rate on spine CPTs specifically.
• Prior authorization owner named, with the turnaround they achieve on fusion requests.
• Monthly report requested: charges, collections, wRVUs, denials, and accounts receivable over 90 days.
• Fee schedule reviewed for the top 20 codes against the Medicare rate in your locality.
• Your own monthly tally, kept outside the practice system: clinic visits by type, cases by CPT, wRVUs, and charges. Reconcile it against the practice report every month; a 5% gap is a coding problem and a 15% gap is a contract problem.
• Referral source recorded on every new patient, so you know which 10 offices send 80% of your volume.
• Time per clinic session and per case logged for the first 90 days. Productivity per hour is the number that tells you whether to add a clinic day or an OR block.

Meet each of them in week 1 and set expectations in writing.

• Surgery coordinator identified, with the checklist they use from booking to the day of surgery.
• Medical assistant trained on your room setup, imaging pull, and post-op protocols.
• Phone triage script for post-op calls, with the escalation path to you.
• Clinic days, OR block days, and administrative time fixed on the calendar for 6 months.
• Block time confirmed in writing, with the utilization threshold that keeps it.

Settle the practical questions before the first shift.

• Call schedule for the next 90 days in hand, with the group's policy for swaps.
• Trauma scope defined: what you cover (fractures, washouts, external fixation) and what you decline.
• Backup for spine emergencies when you are away, with a name and a number.
• Compensation per call day and the payment mechanism for uninsured trauma.