The Nurse Practitioner’s Guide to Creating a Telemedicine Practice

A telemedicine clinic can be a simple, cost-effective side business for nurse practitioners. As younger generations move into adulthood and make independent decisions about their health, the value of telemedicine has become recognized. This swiftly growing business model can be applied to a variety of disciplines—including mental health, weight loss medicine, and hormone therapies. Learn more about the benefits of practicing telemedicine, and how to build your virtual clinic from the ground up.

What are the benefits of operating a telemedicine clinic?

A telemedicine practice grants NPs flexibility, both clinically and legally. Seeing patients virtually can dramatically expand the reach of your practice, allowing you to see patients from areas far and wide. For some disciplines, NPs can even operate their telemedicine business from home.

Practicing via telemedicine can also help NPs mitigate the restrictive laws of some states. In some regions of the country, nurse practitioners are required to employ a supervising physician at their practice. With telemedicine, an NP can register their business in a state with more relaxed laws, allowing them to practice more freely and save on business expenses. It can be possible to physically reside in a state with restrictive policies but establish your telemedicine business in a state with more leniency.

A step-by-step startup guide for nurse practitioners

Setting up a telemedicine practice is relatively easy in comparison to a brick and mortar business. However, some essential supplies are needed in addition to a strong digital infrastructure. Start by registering your practice as an LLC, then begin the launch process from there.

Tech and hardware

Before you start seeing patients, be sure that you have an up-to-date computer, smartphone, and a reliable internet connection. Patient satisfaction can hinge on the quality of your technology. No one wants to deal with a spotty connection during video calls, and lapses in audio or camera streams can make it difficult for patients and providers to communicate. You will appear more professional, efficient, and attentive if your tech is top-notch.

Software and digital tools

In addition to physical equipment, be sure to carefully invest in comprehensive workflow software. Because this practice is run entirely online, it’s crucial to keep close track of patient progress, payments, and appointments via a business intranet system. This software should also provide patients with a seamless user experience, as simplicity will make people more likely to visit you again.

Many telemedicine clinics use the free Google Workplace suite to keep track of business expenses and patient files. There are a number of no-cost HIPAA compliant video chat software platforms, as well as an affordable option supported by Simple Practice. Use Elite NP’s preferred vendor network to find a variety of tech solutions that support the growth of your telemedicine practice.

Marketing materials

Whether you practice online or in-person, marketing is a crucial pillar of a successful medical business. Since your telemedicine clinic is entirely virtual, your marketing plan should be executed strictly through digital channels. In lieu of paid ads, think about utilizing social media to leverage your services and boost visibility.


You can choose to accept insurance through your telemedicine practice, though there are some drawbacks to this model. Insurance plans can have complicated regulations surrounding virtual doctor’s visits, and it may not be worthwhile or cost-efficient to mitigate this red tape. Operating your telemedicine clinic as a cash-only business will streamline billing processes and help you get paid faster.

Budgeting your telemedicine clinic

Elite NP founder Justin Allan established a thriving telemedicine business, and recommends the following model. “I started one [a telemedicine clinic] with $8,000, and $6,000 of that was used to market the hell out of it!” says Allan. “Outside of marketing costs, the actual foundation of your practice should not cost you more than $2,000 to $3,000 at the most. Monthly operational costs would be around $100, and typically consists of internet bills and software membership.”

Deciding on a service niche is vital to your success as a business owner. Elite NP advises against establishing a telemedicine primary or urgent care, as this market is quite saturated. Instead, go for more specialized concentrations, such as mental health and psychiatric care, men/women’s health and hormonal therapy, or sleep medicine.

Another significant startup cost will be licensing. NPs need to get licensed in every state they want to practice in. Licensing costs can add up quickly, but overall most NP licenses will cost $200 to $300 per state. However, these additional fees may pay for themselves relatively quickly because of how much your patient load may grow as a result.

48 Responses

    1. Great idea in theory. One problem I can foresee is that people will want to use their insurance or they can go to the health department and have it done for free. Another limitation would be obtaining lab work. Doing lab work over telemedicine complicates its because: You must send orders in for lab work, most people will want to utilize their insurance, and you need to get results. It sounds like it should be fairly straight forward but sometimes it can be a real headache because of these reasons.

      1. why is it hard to get labs via telemedicine? can’t patients use their insurance for labs even if you’re cash pay? thanks

  1. Hi!
    Thanks for this informative article, I do really want to open my own telemedicine business. I am in Florida, a very restrictive state, but as you said I can practice in another state. I’m wondering how intense you think the marketing would be since I don’t know anyone in another state? I want to apply for my license in NY to start off. Thoughts? Thank you.

    1. The marketing is going to be as intense as any other business starting in a fresh market. Word of mouth referrals will happen but it will take 6-12 months before that happens. So you need to expect that marketing will be your number one expense. Setting up the business itself is easy, but developing a marketing strategy will be your toughest obstacle. I do not know about NY other than it is a densely populated state. Expand your horizons, look at other NP independent states and figure out what your market is going to be for the service you provide.

      1. New York is a complicated state for telemedicine. I have a license there. It is a big ticket item if you want to practice there through a telemed company. If you want to keep your telemed business independent, start with another state. The collaborative issue is strange. (You have to have a relationship to practice, very informal, but still required.) And you can’t get malpractice as an individual practitioner.

  2. I assume you will still need a Dr for collaborative support in states that do not offer full practice authority like TN correct? How would I go about finding one?

    1. You will need collaborative physicians in any non independent state. Which is why you should venture into those states. Having a collaborative physician does nothing but increase your monthly expenses. There are services online for collaborating physicians or simply ask some you know or other NPs who use them. I cannot assist with specifics since I do not advocate for it.

    1. Not at this time. They can be expensive and often times cumbersome if you have a multiple provider practice like I do. We are a very specialized telemedicine practice therefore scripts are just called in. If you have a high volume practice then e-Rx would be necessary to help with workflow. Remember, you want your expenses as low as possible. Creating a Low Overhead Practice

    2. Good information, thank you. My only question is the use of a personal computer. Wouldn’t you need to be HIPPA complaint ? How are you able to ensure this on a personal laptop?

      1. The EMR you utilize will be HIPPA compliant. Do not store anything on your personal computer, problem solved.

  3. Great info helpful.. I have been looking into this and call an app company to start one but cost 40k more than I want to spend and I could not figure how profitable the app would be. Question, I do I need an LLC to start or just build a go daddy site? Please email me at Thanks

  4. Just found you, you are a breath of fresh air. 1yr into NP world and I am a bit burnt out and I’m now on an extended vacay thinking of my next move. Change jobs for sure, but what will change?
    In Telemedicine in another Full practice state, I am currently in a collaborative state,
    > how do you write prescriptions if not escript?
    >How do you ensure you are only taking pts from the state you are licensed in?
    Interested in Telehealth
    But have so many ideas bouncing off my mind right now, men I have been reading your blogs since I woke up, can you imagine
    > I already have a registered LLC whi h I never gir a Tax I.D for. Can I use that, and make some changes, I registered it with my state many yrs ago, but never used it, it was a med legal entity, as you know that’s saturated. may need to change the email address.
    Thank you

    1. 1. I just call the scripts in. Once volume increases then go with an escript services.
      2. Have them upload a copy of the DL into your clinical portal. Often times they will have an address on file too. This is something you do not need to worry about often.
      3. I would suggest registering a LLC in Wyoming or Nevada for privacy purposes and operate under it.

      You sound like you need quite a bit of direction, shoot me an email through the consulting tab if you want to schedule a one on one telephone call.

  5. I am currently working in an endocrinology practice primarily with diabetics of all kinds. since there are so many free/insurance covered services for this demographic would this be a non starter niche ?

    1. Diabetic treatment is a difficult cash niche. Like you said, it is a covered service. Medical niches really need to focus on non-covered services. Now, when it comes to diabetic care, how many diabetics have one on one concierge care from an experienced provider that they can talk with on a daily basis? That could be a niche. Your target market would be individuals in higher income brackets. There are plenty of people with disposable incomes that would pay you for 1 on 1 diabetic care. Guarantee it.

    1. Just a standard professional liability policy is fine. You can go through CM&F group or Berxi. Just make sure they telemedicine is covered.

  6. Do you think ADHD is a good niche or service to offer via telemedicine?
    I worry it’ll come with huge liability

    1. The problem is that the medications are controlled. I think it is a great idea, I do not think there is much liability to it, but you are going to have to wait for the DEA telemed licenses to be released!

        1. You cannot rx controlled substances via telemedicine without 1 in person encounter first. The DEA will begin issuing telemed licenses to counter this dumb law soon.

  7. I’m curious on how to start telemedicine practice on my own, though there is alot of competition with insurances now that most clinics offer telemedicine as adjunjct, what’s a good strategy ?

  8. Hello there! Bought your telehealth couse, but still have a question. If I live in Florida and get a license in WA, I can only provide care to patients in Washington and Florida….correct? So then my marketing would have to be only to those 2 places? Not sure why this is so confusing 🤔 lol! Thank you!

    1. Yes, you can practice in the states you have a license in and you will only advertise in those states, which is easy to do with online advertising!

  9. Looking to start up a telehealth for mens health and after hour primary/sick visit. When setting this up do recommend consulting with an attorney? I’m not thinking it is a must, but a good idea to have a relationship already established.
    Thank you in advance!

    1. Jeffery,

      It is not required. In terms of just establishing with an attorney, I think it is a good idea to have one in the background just in case you need to consult with one as a business owner. Honestly, I haven’t consulted with mine in like 2 years… It is not necessary as long as you are doing everything correctly, as explained in the telemedicine course.

  10. I currently own a brick-and-mortar outpatient mental health practice in CO. I am planning on moving to LA soon. My business is currently set up as an LLC. Can I just use that same business license and business name and just switch my patients over to telemed as long as I apply for a license in LA??

    1. You can still continue seeing the CO patients via telemed as long as you maintain your CO license. You don’t need a LA license for the CO patients. If you are going to start a new practice in LA, then I would start a foreign LLC in LA and just have the CO LLC still be the parent company of that as you are already established. You will need a local LA business license for local patients and the local business.

  11. Hi there!

    I’m in a restricted practice state and have my heart set on Oregon for telepsych opportunities across state lines, however I’m going in circles to find concrete info regarding the ability to do so. The Medical board has specifics related to MDs, PAs, and acupuncturists of which only MDs can apply for a “telemedicine active” license and see patients without having to reside in Oregon. Nothing regarding NPs. No specifics through OSBN either that I’ve come across… do you have any insight on this? Feeling quite discouraged. Thanks! -Angela

    1. I would just contact the BON and ask them… each boards regulations are different but in general, the board of medicines regulations would be applicable.

  12. I am interesting in doing telehealth as a Psych Np but some psychiatric disorders requires some form of monitoring vital signs and labs. How do you safety monitor labs and vitals via telehealth for psych patients?

    1. Those types of patients could be difficult… There are limitations to telemed and that could be one of those limitations. Labs are simple = just order them and the lab sends you results. Vitals can be difficult and would require sending them to have vitals done occasionally at an outpatient facility. If you want to increase the logistics of your practice, then see these patients. If you don’t, then simply avoid seeing the patients that require more complex care. Choose your battles wisely….

      1. Just you are great! Thank you so much. I am interested in purchasing some of your courses. Is bundle pricing available?

  13. Great article! In the case of me having a Florida APRN license, if I added a Washington state license or New York APRN license (now that they are full practice authority) is that all I would need (in terms of NP licenses) to offer telemedicine visits to Florida residents (and NY residents)? I can see how I wouldn’t need a collaborating doc for the NY clients, but for the Florida clients I wouldn’t still need a collaborating MD? Thank you! (I’m am APRN/CNM looking to start a cash only telemedicine practice where I conduct consultations about contraception, fertility methods, sexual and reproductive health, childbirth classes etc.)

    1. As long as the visits in FL are considered primary care, then you don’t need a collaborator. All you need is an active license in the state you want to see patients in. Telemedicine is pretty simple and I go into more specifics in the telemed course just FYI.

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