A Physician of Record, Not a Name on File
A director credentialed where you treat, actively signing scripts and standing orders — not a license rented once at onboarding and never revisited.
Medical Director Oversight
What Medical Director Oversight Actually Runs Through
"Medical supervision" gets used as a catch-all everywhere in this industry, which is exactly why it is worth being specific. In practice it runs through two mechanisms — who is authorized to prescribe, and whose standing orders staff are actually following — and everything else is the paperwork that makes those two things provable.
What It Is
Supervision Is Two Mechanisms, Not a Title
Say a physician "supervises" a clinic and you have said very little — it could mean they are in the building daily, or that they signed something eighteen months ago and have not looked at it since. What actually determines whether a treatment happened under real medical authority is narrower: did a licensed prescriber authorize this specific product to reach this patient, and does a signed, current standing order say a staff member may perform this specific procedure without a physician doing it themselves. Those are answerable with a document, not a description.
MedGrid runs both mechanisms under the same director and the same account. Prescribing routes through a credentialed physician, NP or PA who signs each script inside their own license, DEA status and state. Everything a non-prescriber performs — an injection, an IV placement, a laser pass — runs against a standing order that names the treatment, the conditions and who may perform it. The Prescribing & Scripting page covers the pharmacy side in depth; Protocol Management & Workflows covers the standing-order side. This page is the map between them.
Service Details
The Two Mechanisms Supervision Runs Through
Prescribing Authority, Applied Before You Sign
Every script checked against the prescriber’s NPI, state and DEA status before it goes out — not caught after a pharmacy rejects it.
Standing Orders for Everything Else
What staff may perform without a physician present, spelled out per service and per provider, so delegation is a document rather than an assumption.
Quality Assurance, Not Just a Signature
Complication rates, adverse events and near-misses reviewed against the standing order that authorized the treatment — so a pattern gets caught by your director, not by a board investigator reading the same chart later.
The WorkflowStep 01 Step 02 Step 03 Step 04
How a Treatment Ends Up Under Supervision
Map the Service Against the Mechanism
For each item on your menu, we decide which lever applies — a prescription, a standing order, or both — and who is licensed to authorize it in your state.
License the Right Person to Sign
Prescribing routes to a credentialed physician, NP or PA; procedures route to a standing order your director has actually reviewed and signed.
Load It Where Staff Work
Scripts route to pharmacy inside the platform; standing orders load as protocols staff can find and follow at the chair.
Keep Both Current
Renewed, revised and reissued as license status, state rules or your service menu change — not signed once and left.
Operating Structure
The Management Agreement and the Flow of Funds
The PC and the MSO are connected by a Management Services Agreement (MSA), the contract that defines what each side owes the other and how money actually moves between them.
Step 1
Patients
Cash pay at the point of care. No insurance claims.
Step 2
The PC
Physician-owned. Receives the revenue, pays clinicians, malpractice and clinical supplies first.
Step 3
The Management Company (LLC)
The MSO. Holds the administrative infrastructure for everything non-clinical.
Step 4
MedGrid
Consulting agency to the LLC. Non-clinical services only.
The medical director: in a corporate-practice state the PC pays the director as its own clinician, before any transfer to the LLC. In a state without a corporate-practice bar, the director may instead invoice MedGrid for non-clinical advisory time. Clinical work is always paid by the PC.
Patient Revenue
All clinical revenue is cash pay, earned and received by the PC in its own account, never by the MSO. The PC covers clinician compensation, malpractice and clinical supplies first. Separate accounts, books and payroll keep the physician’s license and your investment protected if either side is ever questioned.
The Management Transfer
On the schedule set in the management services agreement, normally monthly, the PC transfers a fixed, fair-market amount to the management company (the LLC) for the non-clinical services it provides, never a percentage of medical revenue. That percentage is what turns a fee into fee-splitting.
The MedGrid Retainer
The LLC pays MedGrid a fixed monthly retainer, invoiced against a written scope of consulting, accounting, marketing, membership and certification work. MedGrid charges for no medical service and never touches a patient payment.
Who Signs What
The physician signs medical decisions, you sign business decisions, and the MSA keeps that line clean. The medical director is paid by the PC for clinical work, or by invoice to MedGrid for non-clinical advisory time in states where the law allows it.
Inside the Agreement
What a Management Agreement That Holds Up Contains
What the MSO Provides
A written list of the non-clinical services the MSO delivers: brand and marketing, lease and equipment, non-clinical staff and payroll, systems, purchasing and vendor accounts, billing operations and back-office administration.
Flat and Fair-Market
One fixed monthly amount from the PC to the management company, set to fair market value for the services actually provided, followed by a fixed monthly retainer from the LLC to MedGrid. Neither is ever a percentage of medical revenue or a payment per patient or per referral, which is what keeps it from becoming fee-splitting.
Reserved to the PC
Diagnosis, treatment, protocols, prescribing, clinical hiring and discipline stay with the physician-owned entity, in writing. The MSO runs the business around the medicine and does not direct it.
Term, Renewal and Exit
A defined term, renewal terms and termination rights for both sides, plus what happens to records, staff, equipment and patient continuity if the relationship ends, so neither side is trapped and patients are never stranded.
Records, Privacy and the BAA
The medical record belongs to the PC. The MSO touches patient information only as a business associate under a HIPAA business associate agreement, with access limited to what its functions need.
Built to Be Audited
Both sides agree to cooperate with board inquiries, insurer audits and buyer diligence, and the compliance file that supports the arrangement is kept current by the MSO and reviewed by the physician.
Common Ways This Goes Wrong
Four Mistakes We Rebuild Most Often
Most clinics arrive with a version of one of these. They are fixable without closing the doors, and they are the first things a board, insurer or buyer notices.
- A Fee That Is a Revenue ShareA percentage of collections turns a service fee into fee-splitting in most corporate-practice states.
- A Director With No Delegation on PaperA name on a form with no written protocols, delegation or chart review does not show clinical control.
- The MSO Making Clinical CallsHiring or firing clinicians over clinical judgment, or setting treatment, is the control boards read most broadly.
- One Account for EverythingCommingled funds erase the separation between the practice of medicine and the business around it.
General structure, not a legal opinion for your clinic. Your director and counsel confirm the specifics before you treat.
One Platform. Every Workflow.
Prescribing and Protocols Live Together
Because both mechanisms run under the same director and the same platform, a script and the standing order behind it show up in the same history instead of two systems that never reconcile.
Two Pages, One AccountNot Every Service Needs the Same Lever
An IV drip and a compounded prescription are authorized differently. We tell you which mechanism a given service actually needs, rather than layering both onto everything by default.
By ServiceA Different Director per State
Supervision follows the license, and a license is state-specific. A clinic treating patients in three states needs three working authorities, not one director claiming coverage they do not hold.
Multi-stateChart Review on a Real Cadence
Your director checks charts against the standing orders and scripts they signed, on a recurring schedule — not a once-a-year signature that never looks back at what actually happened at the chair.
Ongoing, Not AnnualNP and PA Authority Counts Too
Where your state allows it, prescribing and standing orders can route through a credentialed NP or PA instead of a physician alone — we tell you which license actually has to sign, rather than defaulting to the most expensive one.
Scope-awareOne File for a Board to Ask For
Scripts, standing orders and the chart reviews behind them sit in the same account, so an inquiry into what a patient was treated under is a download, not a scramble across three systems.
Audit ReadyFAQ
Frequently Asked Questions
Still not sure? Twenty minutes on the phone answers what a page can't.
What Is a Medical Director, Exactly?
The physician who holds clinical authority over your treatments — the license your standing orders and prescriptions actually run through. In a strict CPOM state they typically own the PC your clinic operates under; in a flexible state you can own the clinic outright and they still hold the same clinical responsibility. Either way, "medical director" describes the license, not a title on a wall.
Is Medical Supervision the Same as Having a Medical Director?
A medical director is the person; supervision is what they actually do — sign scripts, sign standing orders, review charts. You can have a director on paper with none of that happening, which is the arrangement that does not hold up.
Are You Available in Every State, Including Strict CPOM States?
Yes. We connect clinics with a physician licensed in-state across all 50, including the 17 states that actively enforce CPOM and the 15 more that enforce it in a lighter form. What changes by state is the entity structure and how tightly the PC and MSO have to stay separated — not whether we can cover you.
Do We Need Both Prescribing and Protocols, or Just One?
It depends on your service menu. A clinic that only administers what is already prescribed elsewhere may need standing orders and no prescribing account; one that dispenses compounded product needs both. We map it per service rather than sell you the larger package by default.
What Is the Difference Between This Page and Prescribing or Protocols?
Those two pages go deep on one mechanism each — how a script routes to pharmacy, how a standing order gets built and versioned. This page is the overview: what supervision means as a whole and which lever a given treatment actually runs through.
Can Our Existing Physician Provide This Instead of MedGrid?
Often, for part of it. We review what your physician already signs and covers, keep what holds up, and fill only the gap — whether that is prescribing authority, standing orders, or a state your current arrangement does not reach.
What Does Medical Supervision Cost, and Is a Director Actually Reachable?
Cost depends on your service menu, patient volume and how many states you operate in — we scope it per clinic rather than sell a flat rate, and it is quoted in your proposal, not buried after signup. On availability: your director is credentialed and actively signing for your account, with a defined response window rather than an inbox that goes quiet after onboarding.
Telehealth Setup & ClearancePrescribing & ScriptingProtocol Management & WorkflowsCompliance Frameworks & AssistanceLegitScript CertificationEMR / EHRCollaborating PhysicianBusiness & Marketing ConsultingAccounting & PayrollMarketing Services
General information about how these workflows are structured, not legal advice. Requirements vary by state; your medical director and counsel confirm the specifics for your clinic.