Building a Successful Private

PracticeHeloisa Portela, Ph.D., LPCS, NCC, ACS, RPT-

Start Up Overview• Entrepreneur Hat

• Be Confident!

• Start Part-Time

• Find Office Space

• Set up Phone and Website

• Create Your Forms & Be Clear About Your Rules

Marketing• Decide on a Seminar (and a

1-3 hour Lecture) Topic• Create Your Own or Use a

Package Program

• Plan a Seminar

• Market Your Group at Your Seminar

• You are Building your Client Base!

• Repetition is important

• Letter to referral sources

• Psychology Today

• Personal website

• Employee Assistance Programs

• Networking

• Write a book

• Have a niche!

Plan a Seminar and a group/class (psycho-educational)Example of topics: Parenting, communication in marriage, employment issues. Choose a topic you know well. Systematic Training Effective Parenting; Training In Marriage Eenrichment6 to 8 week class/group recommended1 hour seminar. Invest in MarketingInvest in Marketing - flyers, website, brochures, posters, etc.Find a place that host 20/30/40 attendees(community centers, libraries, church, hospital classrooms, school auditoriums)If your seminar is free, there are public agencies offer you free space. (Confirm that you can circulate marketing material) Market Your Seminar at your lecture!!!Independence (newspaper)Good planning and profession material! Sign up sheet table with contact infoProfessionally made handouts and ppt, printed materialsMake sure your contact info is on all material distributed. Traditionally, around 10 to 20% of the people in your Lecture will sign up for your Group. You also now have a starting database to pull your group from.

Respond to any calls promptly. Have light refreshments. Be enthusiastic!

- Keep your business cards at hand. - Talk about private matters in private.

Choosing Your Space• Options: Be Creative!

• Accessibility

• Think Ahead of Time:

Schedule: How Often?

Exclusive or Shared?

Administrative/Supportive Services?

Copies, Fax, Computer, Group Room?

Referrals?

On call and Emergencies?

Contracts with Manage Care?

Becoming a Partner in an Already Established Practice?

Fee Splitting Versus Flat Fee

Office Space Option:- Rent space by yourself- Aproach an existing counseling practice/counselor to sub-lease- Form a group with other counselors- BE CREATIVE. Doctors office may have space!- Working out of your home

- Think about your clientele when picking your office space. - Disability Access- Elderly

Contract Protects Both Parties!

Sub-Lease Contract• Length of Contract

• Details About Early Termination

• What Happens to Caseload? Case Records?

• Clients Who Call You After You Leave

• Avoid Non-Compete Agreement Clause

Non-Compete Agreement: you can not practice for a certain time (1 year, for example) in a certain mile range

Renting On Your Own• Commercial Rent: Length

• Location

• Structural Changes Needed?

• Confidentiality: Soundproofing

• White Noise Machines, Radio, Fountain, Fan.

• Furniture

• WOW clients!!

- 2-3-4 years.

Phone• Consider How to Answer Your Calls

• Answering Machine in a Landline• Cell Phone• Secretary/Office Manager• Answering Services

• Be Prompt in Returning Calls:

Be The First To Return Calls

First Appointment!

- Be the first to offer an appointment available!!! Most of times, people receive two or three names of counselors and they often follow up with the one who schedules the appointment faster! (and for sooner)

- Be aware that it is easy for your phone call to become a mini session! Learn how to set boundaries!

- Answering Services - $70/month for 75 calls. Extra to call you or page with messages. Extra fee to gather info about client.

- Many insurances will ask for after hours coverage. Consider how you will manage such calls and emergencies.

- Hiring an administrative assistant is the most expensive option. This does expand your practice and clients like this option.

- PT secretary who checks your messages/schedule appointments – think of ROZ

- Office Manager and billing person.

- BILLING ISSUES…

Insurances• Malpractice Insurances:

• HPSO Insurance: 800-347-6647 X. 284• AMHCA: 800-326-2642• CPH: 800-875-1911• NASW: 800-355-3869• APA: 202-336-5700

• Small Business/Commercial/Liability Insurance: Bill Strandberg: 919-460-6145

American MH Counselors Association

Include Slip and Fall Add the owner of your space as an additional insurer under your general liability policy,

Tax ID Number (EIN)• Apply for an Employer Identification

Number (EIN) through the IRS.

• Federal Government recognizing you as a business!

• You will utilize your EIN instead of your SSN for tax payments and income.

Other option: sole proprietor. SSN. Disadvantage: LOTS of people will see your SSN.

National Provider Identifier

• Healthcare professionals use the NPI when billing insurance companies and third party payers.

• For information on how to obtain an NPI:

https://nppes.cms.hhs.gov

Credentialing Process• Council for Affordable Quality Health Care

(CAQH): streamlining the credentialing process:

CAQH.org

888-599-1771

• NPI already in system?

• Referral to CAQH

• Aetna: 800-353-1232

• NetSource Billing: 866-441-1591

If you are already a provider for any of the insurance companies they represent, call them to double-check if you are in their system: 888-599-1771.

Otherwise, apply to be a provider to a specific company AND request a referral to CAQH

Aetna: ask to be referred to CAQH and they will give you an ID number.

Managed Health Care• A reality for private practice

• ACA handout with manage care

• Types: • HMO (Health Maintenance Organization) • PPO (Preferred Provider Organization)• POS ( Point of Service Plan)

• Back-door Access: AD HOC provider/single case agreements.

• Electronic Claim Submission

HMO (Health Maintenance Organization) Less co-payNeed referral from GPOnly approved providersMEDICAID

PPO (Preferred Provider Organization)Choose any provider: member provider, non-member provider (OUT OF NETWORK PROVIDERS)More freedoms to member. Copay costs more. May need pre-approval from insuranceGet payment until service coverage confirmed.

POS ( Point of Service Plan)Similar to HMONeeds a referral

Indemnity insuranceLess frequentSimple billing

Back-door Access: Motivated clientPetition/request in a clear, polite way requesting that the manage care company considers paying the chosen counselorClient will need to send letter to employers benefits manager and the insurance companyCounselor send letter to to insurance company and CC employer requesting consideration of payment for service. RELEASE OF INFO SIGNED!Include qualifications, certifications, and why clinician is a good fit. Follow up with a phone call in two weeks. Payment agreement should be made for the meantime (with reimbursement info if single case agreement accepted)

Walsh & Dasenbrook suggest you can contact the insurance companies and ask for a raise…

Electronic Claim Submission

• Each insurance website

• Website for claims online. Examples: www.navinetclaims.comwww.enshealth.comwww.carepaths.com

• Outsourcing to a Medical Billing Service Company: MHPS: debbiehenderson0624@gmail.com, 704-871-2332

Month fee ($30). No software required.

Mental Health Provider Services

Billing Softwares• Office Therapy and QuicDoc:

http://www.quicdoc.com/

• EZ Claim® http://www.ezclaim.com/

• Therapist Helper® http://www.helper.com/therapist/therapist_helper.htm

• Shrinkrapt® http://www.shrinkrapt.com/

• Office Ally (free) http://www.officeally.com

- EZ Claim starting $400- Therapist Helper $600- Shrinkrapt: $585

Superbill• Name of therapist • Address• City, State, Zip• Office phone number• State license number• Tax ID number (or

SSN) • NPI number • Client Name• (Address)• (Insurance ID#)• (DOB)• (Professional Service

Rendered on - Place of Service)

• Diagnosis:

• (DSM IV)CPT Codes & Services:• 90801 – Diagnostic

Evaluation• 90804 – Individual

Psychotherapy (20-30 min.)

• 90806 – Individual Psychotherapy (45 min.)

• 90808 – Individual Psychotherapy (75 min.)

• 90847 – Family Psychotherapy

• 90812 – Interactive Individual Psychotherapy (45 min.)

• 90831 – Telephone Consult

• 90853 – Group Psychotherapy

• 90885 – Record Review

•  • Missed Appointment• Care Summary Report• Letter• Today’s Charges• Payment

Made this in excel. Before that, I had one in word…

Paper Billing• Health Insurance Claim Form (HCFA)

http://www.dm.usda.gov/shmd/owcp-1500.pdf

HIPAAHealth Insurance Portability and Accountability:

• You need to be HIPAA compliant!!

• Check with ACA! (see handout)

“THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS

Include this note in your Hipaa document.

TREATMENT Use and disclose health information to: • Provide, manage or coordinate care• Consultants • Referral sources

PAYMENT Use and disclose health information to: • Verify insurance and coverage • Process claims and collect fees

HEALTHCARE OPERATIONS Use and disclose health information for: • Review of treatment procedures• Review of business activities • Certification • Staff training • Compliance and licensing activities

OTHER USES AND DISCLOSURES WITHOUT YOUR CONSENT• Mandated reporting • Emergencies • Criminal damage • Appointment scheduling • Treatment alternatives• As required by law

Incorporating the above information will communicate to your client what happens with the healthcare information he or she shares with you.

CLIENT RIGHTS: In the Notice of Privacy Practices counselors are required to inform clients as to their rights under state and federal law. You will need to include information in the following eight sections (with examples):

Right to request where we contact you• Home yes or no • Work yes or no • Cell phone yes or no • If not, how may we contact you ___________________________

Right to release your medical recordsinformation• Must be in writing • You are not obligated to agree• Written authorization to release records to others Right to revoke release in writing Revocation is not valid to the extent that you have acted in reliance on such previous authorization

Right to inspect and copy your medical billing records• Right to inspect and copy records • Counselor may deny this request • Charges for copying, mailing, etc.

Right to add information or amend your medical records• May request to amend record • Number of days to decide • May deny the request • If denied, right to file disagreement statement • Disagreement state and your response will be filled in the record • Amendment request must be in writing

Right to Accounting of disclosures• For a six year period beginning with date the counselor came in to compliance (no later than 4/14/03) Exceptions:Disclosure for treatment, payment or healthcare operations Disclosures pursuant to a signed release Disclosure made to client Disclosures for national security or law enforcement

Right to complain• Please contact you first • If not satisfied, right to complain to the U.S. Dept. of Health andHuman Services • No retaliation

Right to receive changes in policy• May request any future changes • Request to privacy officer

Corporation• Protection from liability! Protect your private assets&

family

• Business Entity

• Taxes and money management

• Discuss with your accountant and financial advisor!

• Types: • Sole Proprietor • Professional Limited Liability Company (PLLC)• Professional Service Corporation

• NCBLPC: http://www.ncblpc.org/license-info/professional-corporation

Sole Proprietor – same tax as personalCorporation – C corp or S corp (salary, distributions, save on employment taxes). Need to use an accountant!!!

Considerations • Bank account

• Credit card for practice

• Merchant account (receive credit card payments)

• Financial Software• Quickbooks• Quicken• Microsoft Money

Merchant account - open at local bank or purchase online: paypal.com; therapymatch.com SHOP AROUND. Fees vary!!! $250-800

Basic Forms• Intake form (Children

and adults)

• HIPAA Notice of Privacy Practice

• Professional disclosure statement

• Informed Consent

• Progress notes

• Release of Information

• Letterhead

• Tracking Sheet

• Transfer plan, counselor incapacitation, or termination of practice

• Sample letters (to Primary Care Physician for referral, to school for tardiness, etc.)

Transfer plan: what happens to client’s records if professional leaves practice, dies, or becomes disabled/unable to practice.

Access information or protocol provided to custodian. The professional counselor will provide the custodian location(s), keys, passwords, access codes and other information necessary or a protocol to obtain this information in order to execute the transfer plan.Notify all active clients of inability to practice. & referral. Possession of clinical records.Requests for information. The custodian will respond to a request for information in concert with state laws, HIPAA guidelines and code of ethics.Maintaining and destruction of clinical records. The number of years that the custodian will maintain clinical records (post treatment) must be specified. A general guideline would be that clinical records would be maintained for a minimum of seven years for adults and ten years for children.Custodian’s contact information included in the informed consent document.

Informed Consent• Your practice information

• Mandated reporting

• Fees and policies

• Transfer plan

• Emergency

• Consent to treatment of minors

• HIPAA

Basic Office Procedures

• When potential client calls

• First session

• Note taking:S – Subjective (what client states)O – Objective (what you observe)A – Assessment (progress towards goals)P – Plan (agreed for before next session)

Ask question on phone while filling out form in computerMail or email formsHire someone to gather infoForms downlodable online

Insurance infoSigned paperwork (consent, HIPAA, initial assessment)Any questions? Review info

Client Retention• Psycho-educational

• How often sessions should happen

• What to expect of course of treatment

• Note client’s progress!

• Focus not just on diagnosis but on life. Help clients have more fulfilling lives!

• Termination

• Follow up!

• Be genuine.

- Educate clients on frequency of appointments- Encourage clients to come

Resources• Private Practice Pointers section for ACA

Members

• Walsh, R., & Dasenbrook, N. (n.d.). The Complete guide to private practice for Licensed Mental Health Professionals. Western Springs, IL: Authors.

http://www.counseling-privatepractice.com/

See Private Practice Development Section! Free