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Healthcare Practices: New Hire Payroll Onboarding (2026)
New hire payroll onboarding at a healthcare practice is the W-4, the Form I-9 within three business days, new hire reporting inside the state deadline, the pay code for the role, and the healthcare practice checks this page cites before the first shift. BEG: $45 per employee per month inside the payroll software you already use, live in 3 to 5 days.
Checks specific to hiring in healthcare practices
Registered nurses licensed by the state examining board generally meet the learned professional duties test and may be treated as exempt only if paid on a salary basis of at least $684 per week; hourly-paid RNs must receive overtime. Licensed practical nurses generally do not qualify as exempt regardless of experience and are entitled to overtime pay.
Physicians, dentists, podiatrists, optometrists and other employees holding a valid license to practice medicine, and residents or interns who hold the required degree, are exempt professionals without regard to the salary level or salary basis tests.
The federal onboarding sequence
Form W-4 (and the state equivalent) before the first check; Form I-9 section 1 on day one and section 2 within three business days; the new hire report to the state directory within its deadline, federal default 20 days and shorter in several states; the pay code, exemption status and direct deposit authorization on the employee record; and for physicians and nurses the pay basis documented so shift differentials is taxed and counted for overtime correctly from the first run.
The rules behind this page, with sources
General information, not legal advice. Every rule below was read on the agency page linked next to it.
- Registered nurses licensed by the state examining board generally meet the learned professional duties test and may be treated as exempt only if paid on a salary basis of at least $684 per week; hourly-paid RNs must receive overtime. Licensed practical nurses generally do not qualify as exempt regardless of experience and are entitled to overtime pay. [DOL Fact Sheet #17N]
- Physicians, dentists, podiatrists, optometrists and other employees holding a valid license to practice medicine, and residents or interns who hold the required degree, are exempt professionals without regard to the salary level or salary basis tests. [29 CFR 541.304]
Read the full guide to how to onboard a new employee in payroll, and the rest of the healthcare practice payroll library.
Managed Payroll, Handled.
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Frequently Asked Questions
Hiring at a healthcare practice: DOL Fact Sheet #17N
Registered nurses licensed by the state examining board generally meet the learned professional duties test and may be treated as exempt only if paid on a salary basis of at least $684 per week; hourly-paid RNs must receive overtime. Licensed practical nurses generally do not qualify as exempt regardless of experience and are entitled to overtime pay.
Hiring at a healthcare practice: 29 CFR 541.304
Physicians, dentists, podiatrists, optometrists and other employees holding a valid license to practice medicine, and residents or interns who hold the required degree, are exempt professionals without regard to the salary level or salary basis tests.
How fast must a healthcare practice report a new hire?
Within the state's deadline, 20 days under the federal default and as short as 7 days in some states. The report goes to the state new hire directory, and a rehire after 60 days is reported again.
What does managed payroll cost for a healthcare practice?
$45 per employee per month, all-inclusive, inside the payroll software you already use, with no monthly minimum. Shift differentials, on-call pay and credentialing-based pay tiers are configured at setup, not billed as add-ons.
Related Resources
Anthony leads payroll solutions at Business Executive Group, a national managed payroll firm serving businesses across industries including Healthcare Practices. BEG manages payroll at $45 PEPM, all-inclusive, with deep expertise in compliance, multi-state filing, and industry-specific payroll requirements. Get instant pricing at beghr.com.
Authoritative source: U.S. Department of Labor: Wage and Hour Division
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