Many Texas medical and dental owners feel trapped between patient care and daily business chaos. Bills, payroll, vendors, and hiring can pull you away from the exam room. Management Services Organization, or MSO, agreements give you another path. You keep control of your professional practice. The MSO handles the business side through a contract. This structure can support growth, protect your license, and reduce stress when done correctly. It can also create risk if the agreement crosses into control of clinical judgment or fee splitting. Texas law draws a hard line between business support and medical or dental decisions. This blog explains how MSO agreements work, what they can and cannot do under Texas law, and what to watch for before you sign. You will also see why many owners review these contracts with healthcare counsel, such as resources at dklawg.com, before making a long term choice.
What an MSO Does for Your Practice
An MSO is a separate company that offers business support to your practice. You stay in charge of care. The MSO runs many non clinical tasks under a written agreement.
Common MSO services include:
- Front desk support and scheduling
- Billing and coding
- Collections and payment posting
- Human resources and payroll
- IT support and electronic records set up
- Marketing and patient outreach
- Facility management and supplies
You pay the MSO a fee for these services. In return, you gain time for patients and family. You also gain structure for growth. Yet you must keep full control of all clinical choices.
Texas Law and the Corporate Practice Ban
Texas follows the “corporate practice of medicine” rule. A business that is not owned by licensed professionals cannot control medical or dental judgment. This rule protects patients from business pressure on care decisions.
You can review plain language on Texas licensing rules at the Texas Medical Board policies and guidelines page. Dental owners can review the Texas State Board of Dental Examiners rules and laws. Both sets of rules stress that only licensed professionals make clinical decisions.
An MSO must respect this line. It can support your practice. It cannot:
- Tell you how to diagnose or treat
- Set clinical protocols
- Reward or punish you for clinical choices
- Control who you accept as a patient for clinical reasons
If an MSO crosses these lines, it can place your license at risk. It can also attract state review.
Key Parts of a Texas MSO Agreement
Every MSO agreement is different. Still, most contracts share several common parts that you should review with care.
- Scope of services. The agreement should list tasks in clear detail. It should describe only business support. It should avoid any control of care.
- Compensation. The fee structure must follow Texas rules against fee splitting. Many owners use a flat fee or fair market value structure.
- Term and exit. The contract should state how long it lasts, how you can end it, and what happens if you leave.
- Control of staff. The agreement should state who employs staff. It should state who can hire, fire, and supervise them.
- Use of your name and records. The agreement should protect your practice name, patient charts, and data.
You should be able to point to clauses that show you keep final say over clinical issues, staffing that affects care, and policies that touch patient safety.
Common MSO Service and Control Split
The table below shows a basic comparison of what an MSO may handle and what you must keep in your hands under Texas law.
| Practice Function | MSO Role | Owner Clinical Role |
|---|---|---|
| Scheduling | Runs phone system and booking tools | Sets rules for urgent and follow up visits |
| Billing and coding | Submits claims and manages denials | Confirms codes reflect actual services |
| Staffing | Recruits and handles payroll | Approves hiring for clinical roles and training needs |
| Clinical protocols | No role | Creates and updates all care protocols |
| Patient marketing | Runs ads and website | Approves messages related to care |
| Equipment | Negotiates purchase and service contracts | Chooses what tools are safe and needed |
Fee Structures and Texas Concerns
Texas law is strict about fee splitting. A non licensed company cannot share in your professional fees in a way that looks like payment for referrals or clinical influence.
Common MSO payment models include:
- Flat monthly fee for listed services
- Tiered fee based on staff or locations
- Cost plus model where you repay costs plus a set margin
A pure percentage of collected revenue can raise concern. It can look like the MSO shares in your professional fees. Some structures use a blended model that ties fees to real business costs and fair market value.
Warning Signs in an MSO Proposal
Some offers seem helpful on the surface but hide pressure points. You should pause if you see:
- A contract that lets the MSO set your clinic hours or visit length
- Bonuses that depend on use of certain tests, drugs, or procedures
- Requirements that you send all referrals to MSO linked providers
- Limits on your right to leave the MSO without extreme penalties
- Ownership transfer of your charts or right to use your name without control
These terms can feel like loss of control. They can also attract state review or patient complaints.
Steps Before You Sign
You can move through MSO talks in three clear steps.
- Clarify your goals. Decide what you want help with. That might be billing, HR, or growth to new sites.
- Map every service to your legal limits. Mark what must stay under your control. Use Texas board rules as a guide.
- Have a healthcare lawyer review the full contract. Ask for clear edits that protect your license and your name.
This process takes time. It prevents painful conflict later. It also protects your patients from hidden business pressure.
Using MSOs to Support Care, Not Replace It
A well built MSO agreement frees you to focus on patients. It can bring calm to billing, staffing, and growth. It can also reduce burnout at home.
Yet no contract is worth your license or your peace. Texas law puts you at the center of every clinical decision. Your MSO agreement must reflect that truth in plain words.
