Buying a medical practice in Jacksonville and Northeast Florida

• More than one clinician seeing patients, so the practice doesn't stop when one person leaves.
• Clean billing: claims paid on the first try, coding that holds up to review, and no open audits by Medicare or insurers.
• A mix of payers (Medicare, Medicaid plans and insurers), with no single one large enough to hurt you if it cuts rates.
• A steady base of returning patients with scheduled follow-ups.
• Referral relationships with many doctors and hospitals, not one.
• An office manager who runs the day without the physician owner.
• In-office services, like lab or imaging, that earn their keep and are set up within the referral rules.
• A records system the staff use well, with a patient portal and online scheduling.

Start with how much of the practice's collections come from the selling physician's own work, and how long they'll stay. Then hire an independent coder to audit a sample of charts: past overbilling can become a repayment demand, and how the deal is structured affects whether that debt follows you. Check every clinician against the federal exclusion list, which names people barred from Medicare and Medicaid.

Read each payer contract to see whether it can be assigned to you, and plan for a gap in cash while new enrollments and credentialing go through. If any referring doctor owns part of the practice, or the practice sends patients to labs, imaging or therapy it owns, have a health care attorney check the arrangement against federal law and Florida's Patient Self-Referral Act (section 456.053). Ask about malpractice claims and who pays for the seller's tail coverage (insurance for claims filed after a policy ends). Work out with your attorney how patient records will transfer and who will keep them.

• How much of the practice's collections come from your own visits, and how long would you like to keep practicing here?
• Which insurers make up most of your revenue, and when did you last renegotiate your rates?
• Who handles billing and coding, and has the practice had any audits or repayment requests?
• What brings in revenue besides office visits?
• How do new patients find you, and which doctors or hospitals send you the most?
• Who owns the practice today, and does it have an AHCA clinic license or rely on an exemption?
• Do your other clinicians have contracts, and are any of them planning to leave?

This region covers Duval, St. Johns, Clay, Nassau, Baker and Putnam counties: Jacksonville, Jacksonville Beach, St. Augustine, Ponte Vedra Beach, Orange Park, Fleming Island, Green Cove Springs, Fernandina Beach, Yulee, Macclenny and Palatka. Jacksonville merged with most of Duval County in 1968, which makes it the largest city by land area in the lower 48 states.

The economy leans on logistics, the Navy and financial services. Logistics runs through JAXPORT, major rail lines and the meeting of Interstates 95 and 10. The Navy has Naval Air Station Jacksonville and Naval Station Mayport. Insurance and health care matter too. St. Augustine, founded by the Spanish in 1565, and Amelia Island draw steady tourism. Trucking and logistics firms, the building trades, medical practices and home services all fit this market.

Northeast Florida is less seasonal than South or Southwest Florida, with fewer winter residents and more year-round employers. Direct hurricane landfalls have been less common here than on other parts of the coast, but storms still bring flooding along the St. Johns River and the beaches, so check insurance costs and flood zones.

Military families bring skilled workers and working spouses into the labor pool, though they also move on when orders change. St. Johns, Clay and Nassau have added the most new homes, and companies serving those suburbs have grown with them. Georgia is close, and some companies here serve customers across the state line. Work in Georgia may need Georgia licenses, so ask how much revenue comes from there and who holds those licenses.