First job questions

[Sanman]

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Hey guys,

I'm looking at a few jobs (non-licensed) at private practices in addition to clinics and post-doc fellowships. I was wondering, what kind of split would be considered competitive in these kinds of arrangements? It is largely therapy and involves a new behavioral medicine program that the group is starting. I had not really considered these types of arrangements, but the work is interesting and up my alley. What other negotiating points should I bring up?

 

[erg923]

Hey guys,

I'm looking at a few jobs (non-licensed) at private practices in addition to clinics and post-doc fellowships. I was wondering, what kind of split would be considered competitive in these kinds of arrangements? It is largely therapy and involves a new behavioral medicine program that the group is starting. I had not really considered these types of arrangements, but the work is interesting and up my alley. What other negotiating points should I bring up?

First, I would ask how they are going to pay you? Assuming they rely on insurance reimbursement, they cant bill for your services if you're not licensed...in most states anyway.

 

[Duck Duck Goose]

First, I would ask how they are going to pay you? Assuming they rely on insurance reimbursement, they cant bill for your services if you're not licensed...in most states anyway.

Maybe I missed something in the OP but I know for sure that unlicensed clinicians can bill insurance for services as long as they're supervised by a licensed clinician in at least the 4 states that I've worked in (as a Master's level therapist)... Seems unlikely that these 4 states are all exceptions.

 

[sydb1367]

in CA you can.

but Duck, were licensed at the master's level? 'cause that likely changes things.

 

[AcronymAllergy]

in CA you can.

but Duck, were licensed at the master's level? 'cause that likely changes things.

Definitely changes things. I think in general, it's fairly tough to bill for the services of an unlicensed professional, even if that professional is working toward licensure, although it depends on the insurance and state.

 

[Duck Duck Goose]

Definitely changes things. I think in general, it's fairly tough to bill for the services of an unlicensed professional, even if that professional is working toward licensure, although it depends on the insurance and state.

Hi, no, I wasn't and am not licensed at all (if I don't Match for internship, I'll look into it). I've known lots of people with different Masters degrees who provide therapy and the agency/practice they work for bills insurance and gets paid because the provider is supervised by someone with a license (some psychologists some other mental health professionals). This is definitely a business model in the four states that I've worked in. And apparently CA, too.

Again, maybe I'm missing some part of what's being said in this thread but people who are unlicensed (possibly working toward licensure but not necessarily) but have the "proper degree" are able to bill insurance when supervised by a licensed practitioner. I don't think it can be that difficult to bill insurance as an unlicensed clinician in these states (maybe the Northeast is less stringent about this?) because it's how many agencies bill the majority of their hours. (Also, I wasn't working for shady places. 😛 )

 

[ForensicNeuro]

From my understanding practicing in multiple states: If the place receives a specific amount of government money then unlicensed professionals can bill with the signature of a licensed psychologist or psychiatrist. If the facility or agency does not (private), then that would be fraud....most likely via a fee splitting arrangement (i.e. you see the client...supervisor bills...reimbursement is split or playing with the coding of services)

 

[Sanman]

Now I confess that I may be wrong. However, it was my understanding the the limited permit that you receive in many states upon completion of a PsyD/PhD (NY in my case) allows one to see patients under the supervision of a licensed psychologist. The permit is not necessary for those working for any governmental agency as they are exempt from these laws. In NY, state law says that assessment must be performed by a licensed psychologist, so I would not be able to do that unless it was a cash transaction. Let me know if I am incorrect.

 

[Duck Duck Goose]

From my understanding practicing in multiple states: If the place receives a specific amount of government money then unlicensed professionals can bill with the signature of a licensed psychologist or psychiatrist. If the facility or agency does not (private), then that would be fraud....most likely via a fee splitting arrangement (i.e. you see the client...supervisor bills...reimbursement is split or playing with the coding of services)

So if X Medicaid dollars are coming in, the agency can bill insurance for unlicensed practitioners with licensed supervisors? All the places I've worked have accepted Medicaid clients so that might explain it. Only one was state-related, though.

If that's not what you meant, then I don't see/understand how these places could be committing insurance fraud for decades without anyone noticing it. My name and degree were on all documents that I prepared. After I prepared and signed documents, supervisors reviewed and signed my work (in 3 states). In the 4th state, with my Masters, I didn't need the supervisors' signatures for notes but I did for intakes/terminations. A non-MA level practicum student at one of these sites in this state did need the supervisors' signatures for notes but I didn't as a student with my MA at that site/state. Definitely not fraud, my name and degree are on all the documents.

For assessments, some insurance companies required that a licensed psychologist conduct and compose the entire assessment, while others allowed psychometricians (i.e., students or MA level people at these particular sites) to conduct the assessments and compose a report in conjunction with a licensed psychologist, with both signing off on the report.

I think it's telling about the nature of psychology grad programs that we students don't know who can bill what, despite being in multiple settings during our training. We need some business skills!

 

[AcronymAllergy]

So if X Medicaid dollars are coming in, the agency can bill insurance for unlicensed practitioners with licensed supervisors? All the places I've worked have accepted Medicaid clients so that might explain it. Only one was state-related, though.

If that's not what you meant, then I don't see/understand how these places could be committing insurance fraud for decades without anyone noticing it. My name and degree were on all documents that I prepared. After I prepared and signed documents, supervisors reviewed and signed my work (in 3 states). In the 4th state, with my Masters, I didn't need the supervisors' signatures for notes but I did for intakes/terminations. A non-MA level practicum student at one of these sites in this state did need the supervisors' signatures for notes but I didn't as a student with my MA at that site/state. Definitely not fraud, my name and degree are on all the documents.

For assessments, some insurance companies required that a licensed psychologist conduct and compose the entire assessment, while others allowed psychometricians (i.e., students or MA level people at these particular sites) to conduct the assessments and compose a report in conjunction with a licensed psychologist, with both signing off on the report.

I think it's telling about the nature of psychology grad programs that we students don't know who can bill what, despite being in multiple settings during our training. We need some business skills!

So true. Sigh.

I know that the sites I worked for in grad school didn't attempt to bill insurance, so it wasn't an issue charging for our services there. They of course made sure to let patients/clients know they'd be seen primarily by graduate students who were under the supervision of licensed psychologists. That, and I worked for hospital consultation services that were free to the patients, with our stipends being paid for by training grants.

 

[aequitasveritas]

Hey guys,

I'm looking at a few jobs (non-licensed) at private practices in addition to clinics and post-doc fellowships. I was wondering, what kind of split would be considered competitive in these kinds of arrangements? It is largely therapy and involves a new behavioral medicine program that the group is starting. I had not really considered these types of arrangements, but the work is interesting and up my alley. What other negotiating points should I bring up?

Anything below a 50/50 split is potentially exploitative of your position IMO. I think 70/30 your way is a good split.

You need to really read your contract to see what is stipulated in: 1. how you obtain patients, 2. if there is a quota you must make in a pay period, 3. whether they will provide you with malpractice (not a big deal money wise as its cheap...just make sure you get it.), 4. What termination contracts look like- what happens when you stop working there...do patients come with you (which is what you want) or do they stay? If they require that they stay I would question the ethics of the group.

You've really got to be on your toes as a psych assistant. Make sure you read the liability portions of the contract...what you will be responsible for aside from your supervisor. This makes no difference in the eyes of the board but it does matter in civil court.

You should know:
in most sates, your employer must pay your board application fees, advertising fees, office costs, rent (it is usually illegal for you to pay rent). Don't budge from these. If someone tries to make you do them, find out the laws and then make a decision to stay under a modified contract, or decide the person is unscrupulous and depart.

 

[Sanman]

Anything below a 50/50 split is potentially exploitative of your position IMO. I think 70/30 your way is a good split.

You need to really read your contract to see what is stipulated in: 1. how you obtain patients, 2. if there is a quota you must make in a pay period, 3. whether they will provide you with malpractice (not a big deal money wise as its cheap...just make sure you get it.), 4. What termination contracts look like- what happens when you stop working there...do patients come with you (which is what you want) or do they stay? If they require that they stay I would question the ethics of the group.

You've really got to be on your toes as a psych assistant. Make sure you read the liability portions of the contract...what you will be responsible for aside from your supervisor. This makes no difference in the eyes of the board but it does matter in civil court.

You should know:
in most sates, your employer must pay your board application fees, advertising fees, office costs, rent (it is usually illegal for you to pay rent). Don't budge from these. If someone tries to make you do them, find out the laws and then make a decision to stay under a modified contract, or decide the person is unscrupulous and depart.

Thanks! I know that he would be covering rent/office costs/advertising costs. He also offered to pay for any assessment materials I would need if there was a way to make assessment billable (cash assessments,etc). Approximately half my referrals would come from the clinic, but I would have to market myself increase referrals beyond that.

 

[sydb1367]

Thanks! I know that he would be covering rent/office costs/advertising costs. He also offered to pay for any assessment materials I would need if there was a way to make assessment billable (cash assessments,etc). Approximately half my referrals would come from the clinic, but I would have to market myself increase referrals beyond that.

why is it not already billable?
again this will vary by state and insurance, but my supervisor bills medicare for the assessments I do.

as for the original question, I had asked around about that myself. the responses ranged from 60-40 favoring the psych assistant to 60-40 favoring the licensed psych. with the majority actually saying the latter. But, I was also told that this would vary widely based on geography, even city to city. So I was advised to utilize the local county psychological association listserv to ask what the "usual and customary practice" was. Might be worth a shot.
AqV, are you seeing a lot of psych assistants getting 70-30 in their favor in your locale?

Approximately half my referrals would come from the clinic, but I would have to market myself increase referrals beyond that.

In CA, marketing yourself to get referrals as a psych assistant can get you into trouble because it can be viewed as promoting yourself as an independent practitioner, rather than as the employee of a psychologist. check your state's rules.

 

[Sanman]

why is it not already billable?
again this will vary by state and insurance, but my supervisor bills medicare for the assessments I do.

In CA, marketing yourself to get referrals as a psych assistant can get you into trouble because it can be viewed as promoting yourself as an independent practitioner, rather than as the employee of a psychologist. check your state's rules.

I believe that the reason that insurance would not cover assessment is that NY generally requires a licensed psychologist. I would have to check into whether it is even legal for me to perform the assessment.

I would be marketing the behavioral medicine program I would be running for the clinic, not myself as a practitioner. However, I might be responsible for speaking to or providing community outreach and professional education to physicians who might refer to the program. Obviously, I would not misrepresent myself doing this.

 

[aequitasveritas]

AqV, are you seeing a lot of psych assistants getting 70-30 in their favor in your locale?

It's lessening these days as the economy nose dives and "therapists" abound more than the population demands. I have a 60/40, which is fair.

About 10 yrs ago it was common to see 70/30.

 

[Sanman]

Hey guys,

Thanks for all the help. The split turned out to be 60-40 (in my favor). I am still reviewing the rest of the terms, but it looks like all overhead except malpractice will be covered by him.