How I billed $800,000 worth of services in 2022 and how I plan to reach $1,000,000 in 2023.

[PsyDr]

The VA does it all of the time. You have a regular supervisor who may not always be on site, and then an on-site supervisor for as-needed issues.

I know many psychologists who are on vacation while the interns work without them.

VA policy does not trump federal law. I know many physicians who are violating this law too.

42 CFR 410.32

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[cara susanna]

However, there still needs to be an on-site supervisor. The supervision rules were relaxed as a result of the ongoing public health emergency. However, supervisors will need to return at the conclusion of the public health emergency. This came up when the government waited till the last minute to renew the public health emergency last year.

Right, so as long as you have an on-site supervisor available, the formal supervisor doesn't have to be on site all of the time or even at all?

 

[Sanman]

Right, so as long as you have an on-site supervisor available, the formal supervisor doesn't have to be on site all of the time or even at all?

I believe that is the rule only during the public health emergency. Once that expires (I think 2024 at this point), all the formal supervisors would have to be on-site full-time. When it was set to expire, we were scrambling to get everyone back (and find office space) and then it got renewed at the last minute.

 

[erg923]

I believe that is the rule only during the public health emergency. Once that expires (I think 2024 at this point), all the formal supervisors would have to be on-site full-time. When it was set to expire, we were scrambling to get everyone back (and find office space) and then it got renewed at the last minute.

Arguing about nonsense whilst master's level providers and below provide most of the "mental health services" in this country.

Some psychologist skirts some boundaries and we want to kill him/her? Silly. Good for him/her. Some parts sound a bit, eh.... but whatever. I'm sure they are smart enough to avoid blatant billing fraud whilst using interns or externs in the name of..."ME and mu connections"... as we have all always done. Not really much to see here. Think dude has some debt to pay off too, btw.

I don't understand not wanting to leave work to work-out, play golf, and/or eat a proper lunch in the name of 50 more dollars though. That's like... my whole day to me. I'm eating a turkey san and f-ing off for bit, right?

 

[cara susanna]

I believe that is the rule only during the public health emergency. Once that expires (I think 2024 at this point), all the formal supervisors would have to be on-site full-time. When it was set to expire, we were scrambling to get everyone back (and find office space) and then it got renewed at the last minute.

Lol, that is not my experience even from before the pandemic. Now I'm worried because I just got approved to become a remote supervisor (I'm at a CBOC and the internship is at our main hospital). I was told it wouldn't be an issue.

 

[AcronymAllergy]

Right, so as long as you have an on-site supervisor available, the formal supervisor doesn't have to be on site all of the time or even at all?

My understanding is that there always needs to be someone on-site when interns are also on-site. It does not necessarily need to be their rotation supervisor.

If interns are providing services remotely from home, they must have an identified supervisor available. Whether that supervisor needs to actually be in the session with them depends on the individual intern and their rated levels of competency.

To add to what others have said RE: practica, some sites provided me a stipend and tuition remission (usually requiring 20+ hours/week), while others did not (usually these were in addition to the primary practicum placement or TA/RA gig). Our tuition remission and stipend had to come from somewhere, whether it be funding from a practicum site, the campus clinic, or a TA/RA position.

 

[cara susanna]

My understanding is that there always needs to be someone on-site when interns are also on-site. It does not necessarily need to be their rotation supervisor.

If interns are providing services remotely from home, they must have an identified supervisor available. Whether that supervisor needs to actually be in the session with them depends on the individual intern and their rated levels of competency.

Yes, that's what I assumed and how every training site I've been at has operated (pre pandemic).

OP: Sorry to threadjack, btw!

 

[Sanman]

Lol, that is not my experience even from before the pandemic. Now I'm worried because I just got approved to become a remote supervisor (I'm at a CBOC and the internship is at our main hospital). I was told it wouldn't be an issue.

I would need to double check the guidelines that are in my email somewhere. IIRC, there were some vagaries about supervision being onsite. However, my concern has always been availability of on-site supervisors when I was supervising remotely. If there is no paperwork confirming that they are taking responsibility on-site and a few people take off, is there a risk of no on-site supervisor? If you are the official supervisor that responsibility/problem ultimately falls on you.

 

[AbnormalPsych]

Right, so as long as you have an on-site supervisor available, the formal supervisor doesn't have to be on site all of the time or even at all?

This is how it has worked every place I've ever been.

 

[TrackCPD]

I think OP ghosted us

 

[PikminOC]

VA policy does not trump federal law. I know many physicians who are violating this law too.

42 CFR 410.32

I don't know much about this with physicians as interns usually work in a hospital. At least they did when I trained.

 

[futureapppsy2]

So, in September of this year, the OP posted about grossing $280k this year: How much money do you make and transparent salary/job offer thread?

I'm legit curious how the OP almost tripled that by the end of the year--maybe a few lucrative new IOP contracts? (Also, please come back, OP!)

 

[PikminOC]

So, in September of this year, the OP posted about netting $280k this year: How much money do you make and transparent salary/job offer thread?

I'm legit curious how the OP more than tripled that by the end of the year--maybe a few lucrative new IOP contracts? (Also, please come back, OP!)

Maybe gross vs net?

 

[futureapppsy2]

Maybe gross vs net?

The OP also said “gross” in the original post—that was my error, and I edited the post to correct it!

 

[texanpsychdoc]

I don't blame the OP for not coming back for their weekly round of interrogations by strangers. Just saying. I am genuinely impressed with how they went about this. I probably wouldn't do it myself but still, for me at least, I was a bit impressed.

 

[futureapppsy2]

Real talk...this seems like a ticking litigious time bomb just waiting to go off.

I'm curious what about it seems risky to you. It's a lot of billing, but I don't see anything illegal/unethical described--just high negotiated rates and maximazing highly imbursed codes, both of which is often just good business sense.

 

[ThatPsyGuy]

I'm curious what about it seems risky to you. It's a lot of billing, but I don't see anything illegal/unethical described--just high negotiated rates and maximazing highly imbursed codes, both of which is often just good business sense.

Bit of a derail question, but how does negotiating insurance rates work?
The way I'm imagining it is that when your start up a practice, you just have some standard insurance rates and reimbursement right?
After you've established your practice and had your clients, you go to some insurance representative(?) or higher and schmooze em to get them to like you with meetings or something. Then when you actually start negotiating, you show what CPT codes you're using a lot, client data, outcomes, etc and try to sell yourself for better rates? Like if I take OP's example would it be something like:

"I'm Group Therapy OP at Group Therapy Practice LLC. We have a bunch of people coming in for group therapy. They're consistent, our ratings are all 5 stars, and we're expecting more from referrals. We serve a specific in-demand population that isn't touched upon in this local area and expectations for an increase in clientele are thiiiiiiis big. Here's our CPT codes, data, and all this technical stuff that I broke down so that even my grandma can understand. Can I have more money?"

Was never really taught this, and I doubt I'm going to be taught this formally in any capacity.

 

[psychpro]

What are some things you do to keep your groups full? Also are you comfortable sharing your expenses?

 

[Therapist4Chnge]

Bit of a derail question, but how does negotiating insurance rates work?
The way I'm imagining it is that when your start up a practice, you just have some standard insurance rates and reimbursement right?

1. Know your market. You’ll want to know what the top couple/few employers in your area offer in regard to insurance plans, as that will likely be the largest pool of patients.

2. Know your competition. You can Google based on your preferred patient populations. See who pops up. You can even call to inquire when their next available appointment date/time.

3. Take a look at the in-network providers in whichever plan or plans you are considering. Typically the directories are horribly out of date (on purpose, to look larger than is real). Ghost networks are common, so calling/googling around you’ll likely find retired, dead, & many clinicians who left the panels.

4. Know your neighborhoods. If you live in a $$$ area, that doesn’t mean ppl will cash pay, but if it’s an older population…they *will* want to use their Medicare.

5. Working in a niche area can be very very helpful. It’s been years since I’ve negotiated a commercial contract, but the rates need to be at least Medicare + 10-20% (% changes depending on your other referral/payor sources).

6. Never ever ever ever ever accept their first offer bc it will be a sucker offer. If they aren’t even in the ballpark to start, don’t waste your time bc they won’t likely make big jumps from the start. If you happen to provide a unique service (e.g. assessment, groups, etc), it’s much easier to negotiate.

7. If you are friendly w other practices, see if they will let you see their commercial rates. Technically they shouldn’t show you bc insurance companies tend to put clauses in their contracts saying you can’t, but…are they enforceable…..*shrugs*

8. If you offer a specific service in a demand area, they will find you. I start at my standard rate and then decide how much I’m willing to shave off. For me, anything less than 85% of my cash pay fees was my limit, mostly bc I didn’t need them.

9. Always read the contracts closely & have a lawyer review them too. Cross out stuff liberally. Most places will say it’s a dealbreaker, but they can ask for ridiculous things.

10. I always preferred single case contracts. I’d draw up the terms, including 50% or 100% retainer, require payment within X days, & put in the max % interest fee allowed by state law for all late payments. Some places will balk at this, but again…if you offer a niche service, they might cave. I prefer this method even if I know they have multiple patients bc then they are using my terms and I can walk whenever I want. Again, not likely if you are 1 of dozens, but for niche work it’s great.

I’ll never take commercial insurance again, but I’d consider a single case contract for 85%-90% my cash pay rate. I’d require full payment up front (assessment work) or a hefty retainer (for therapy/other services).

 

[smalltownpsych]

Just wanted to say good job setting the bar higher. Also, making me think going an IOP route. Also, jealous about your ability to get such high insurance reimbursement. I billed 153k last year and projected to bill 240k this year based on current monthly revenue. I plan on starting a transitional/IOP program this summer so that should increase the revenue, but might be awhile before I get up to the numbers you’re hitting. 😁

 

[Sanman]

Just wanted to say good job setting the bar higher. Also, making me think going an IOP route. Also, jealous about your ability to get such high insurance reimbursement. I billed 153k last year and projected to bill 240k this year based on current monthly revenue. I plan on starting a transitional/IOP program this summer so that should increase the revenue, but might be awhile before I get up to the numbers you’re hitting. 😁

@smalltownpsych, I feel like it has been a little while since you gave us a PP update. Glad things are still moving along.

 

[smalltownpsych]

@smalltownpsych, I feel like it has been a little while since you gave us a PP update. Glad things are still moving along.

Yeah. Mainly because I have been fairly busy which is a good thing. Last couple of months of the year were lower revenue because of holidays so still just kind of chugging along. This summer is when I start trying to market an aftercare support to the private pay residential treatment market. Some of that delay because I was in a non-compete and some because of needing to have structure in place. I really need some good months to build up a bit more of a financial cushion for the additional investment for expansion so we’ll see how it all goes in the next six months. March will be one year in and we are making it work and not going broke so that’s a success in my eyes.

 

[studentdoctorsnetwork123]

The italicized alternative you listed here actually sounds like an ethical, common supervisory relationship. The portion I have bolded seems like you acknowledging that you are likely not meeting the supervisory requirements for wherever you practice, but rationalizing your unscrupulous practices as "on the job" and "real world" training.

Also, I didn't know that EMDR was so lucrative.

To the moderators, I apologize if my tone is unnecessarily antagonistic, but I think this is a prime example of how students can be exploited, and how the proliferation of diploma mills has ushered in a wave of these types of practices. I am going to speculate that this practice is comprised of students from those same institutions.

edit: before the ninja privacy change, OP noted they attended one of the main for-profit offenders in the past.

How did you find out that this was EMDR?

 

[borne_before]

This whole thread kind of reminds me a story:

Ooh, it must've been about seven, eight years ago. Me and the little lady was out on this boat, you see, all alone at night, when all of a sudden this huge creature, this giant crustacean from the paleolithic era, comes out of the water. We was so scared, Lord have mercy, I jumped up in the boat and I said "Thomas, what on earth is that creature?!" It stood above us looking down with these big red eyes,-Oh, it was so scary! -and I yelled. I said, "What do you want from us, monster?!" And the monster bent down and said, "...Uh I need about tree-fitty." Three dollars and fifty cents. Tree-fitty. That's right. I said "I ain't giving you no tree-fitty you goddamn Loch Ness monster! Get your own goddamn money! I gave him a dollar. She gave him a dollar. I thought he'd go away if I gave him a dollar. Well of course he's not gonna go away, Nellie! You gave him a dollar, he's gonna assume you got more!