Private Practice in Progress

[Sushirolls]

My overly honest time description is rife for improvement. I will be more efficient as the the demand for efficiency increases. I'll eventually be on SDN less. Early on with any practice there are learning curves and work flows that need to be worked out. This thread should help some of those things be stream lined for folks. But if people are only looking for 1-2 days of work, only do a cash practice. If you want more days do cash or insurance. But a low volume few hours insurance practice will be a disproportionate time suck, unless you restrict it to one maybe two insurance companies.

In summary, don't let my description of time spent be a barrier to your private practice entry, I am quite confident most every other person who does this is fully capable of dialing down the admin fluff to a true bare minimum.

Conversely, when I was with Big Box shops there were still time sucks of meetings, clinical notes/faxes/PAs/call backs, etc or charting burdens that sucked up more time outside the office. Very few people practice in a way where after the patient encounter there is minimal to do after that.

I have no intention to go back to a big box shop and don't anticipate the future of this practice being a time suck as years roll on.

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[clausewitz2]

Aaaaaaaand this is discouraging again, lol. I do realize building a practice from the ground requires a lot of admin work, but 25+ hours per week towards the end of the second year sounds awful. It's probably not as bad as it sounds as your post seems very comprehensive and maybe during/after 4th year I'll feel different, but that much time on admin for an outpatient practice would not be something I think I could maintain. Thank you again for this thread though, it really is an awesome resource and I've learned a ton about the non-clinical aspects of outpatient psych. Hope things keep growing and improving and that you're enjoying the freedom from the big boxes!

This is very much at the tail end of the distribution of admin time: clinical time ratios. It is not strictly speaking a necessary thing. In my worst weeks admin-wise I probably have the inverse ratio, honestly.

 

[trophyhusband]

Hello all, since SDN has been so useful over the years my wife would like to contribute to this discussion. I’ll probably update quarterly for a bit but no promises so I’ll just add this to Sushi’s post and not start a whole new one. Below is going to be a fairly long writeup about starting a cash practice so I’ll post the financial info separately so you can just skip to the next post if you’re not interested.

Late last year there were discussions at my wife’s work about changes to how her current place of work will be run. There were several changes but the big one is that in August of 2021 they will now start accepting insurance payments (and Medicaid) vs the capitated system with small patient fees at point of service they had always used in the past. There are currently no discussions about tracking productivity and whatnot but you know that’s coming eventually.

The other main issue with her current job is that some of you might remember from my last posts on here that she was negotiating a much higher salary than the doc she was replacing. She was successful but there is another doc who has been there for 16 years. This doc’s schedule is always less full than hers and let’s say the patient interactions are problematic so she receives a lot of transfers from said doc. She found out that this doctor’s salary was bumped up to the same as her salary when she was hired on… so she essentially negotiated for both of them and the other doc does much less work.

At this point I convinced her to start a small half day a weekend CAP cash practice (in her current job she only sees adults). I’ve been telling her for years that she should start her own practice because she bureaucracy chafes her and she doesn’t really like having to answer to a boss. This above change and the realization that she was making the same as the other doc finally spurred her into action.

Starting the Practice

We started doing the legwork of building the practice in September of 2020. She filed for an LLC and we purchased a domain for her website (luckily city name + psychiatry.com was available) and I built the site over a weekend. That was an interesting experience since I’ve never done it but based on @RomanticScience’s advice via PM’s (both he and this post of Sushi’s were tons of help) I was able to use Google Sites to build it fairly quickly… attaching it to the domain was not as intuitive as I would have hoped but I figured it out eventually. I was also able to used Google’s auto attendants to set up a phone tree that seems to work fairly well.

She was able to find a small office that only costs $250 per month and has 3 year options to re-up at 3% increases. Her furniture was bought fairly cheaply and the only real office equipment is a computer, wifi/router combo, and a printer/scanner. Buy your own router/wifi that works with your cable internet provider, the one I bought cost like $80 whereas the cable company wanted to charge $16 a month to lease theirs. She also bought a scale for weight/height, an automatic BP cuff, and a white noise machine… think that’s about it for office supplies.

She paid someone to create her logo and had a sign added to the building marquee and had a logo added to the window outside of her office so she’s easier to find. Total cost for all of that was probably around $900. Maybe not the best use of money but she’s happy with it.

Monthly recurring expenses include cable internet $100, Google Workspace $12, Google Voice $27, and Psychology Today listing $30. She was on the monthly plan for Luminello at $100 but they just raised their prices by 20% so we moved her to the annual subscription since she’s not leaving it any time soon so might as well save the 20%.

Other expenses include malpractice which she’s paying the part-time rate for up to 20 hrs a week. CME, MOC, and credit card processing fees.

Plans Change

As I stated above the plan was to only start a small PP one half day a weekend. There was another cash only adult Psychiatrist in town so my wife got in touch with her to pick her brain and see about getting any child referrals from her (that doc only took patients who were 18+). In the course of their discussion they found that their practice styles were very similar and the doc decided to share a secret with my wife that she was closing up shop at the end of the year after 16 years. She worked with an NP who covered her vacations and whatnot so most of her patients would probably stay with her but there were certain patients who wouldn’t want to be seen by an NP. So she offered to refer those patients to my wife.

Between those patients and any kiddos she got a half day a week wasn’t going to cut it. So she informed her current job that she’d be cutting back to 4 days a week at the start of 2021 and they agreed (not that they really had a choice).

Things started off slow as she only had 8 patients through Dec of 2020 but that was fine as she was only working the half day on Saturday. She spent quite a bit of time calling various therapists in the area to work on a referral base. She was fairly successful with adult therapists but had a hard time getting in touch with the child ones so most of her patients are currently adults. As she has gotten more kiddos via internet searches they’ve been reporting back to their therapists and now the referrals are starting to come in.

Things with the local PCPs have largely been a bust. They’re all employed by the large local hospital system and for CAP the system has one full time Psychiatrist and couple of Pediatricians who play CAPs and an NP. The local CMHC has a CAP and a couple of adult docs.

Plans Change X2 or “You’re going to need a bigger boat”

As things progressed into 2021 her referrals from therapist started growing and there was a decent number of inquiries from Psychology Today. It seemed like 1 day a week was going to be sufficient for a while and she’d be able to at least replace her income lost from dropping a day at her main gig.

Then we found out that one of the adult docs at the local system announced he was retiring. Most of the docs at the system were no longer taking patients anyway and the “providers” that were still taking patients were scheduled for months out. Then one of the other adult docs announced that he was moving and we later found out that two other folks are leaving as well (no idea if the two others are docs or NPs). The local system now has an exodus and they were already relying on locums for their inpatient unit. The system is building a whole new hospital with an inpatient unit and I told the wife that I wouldn’t be surprised if they just scrap their MH services entirely and convert that unit to something else (we’ll see time will tell).

There was also the 78-year-old doctor feelgood in town who got forced into retirement (presumably by the DEA). Oddly enough she sent in a request to become a patient of my wife’s but she wasn’t comfortable with the med regimen (one med from each class basically) or her age… the wife mostly tries to stick to 60 and below but she has a couple of 65+.

And the final straw was that her current job would require her to become a full Medicaid accepting physician but she has one autistic patient in her practice that is on Medicaid that she was not willing to fire. She also anticipates that she’ll be getting more autistic/DD individuals as she has a lot of experience working with those folks and word is starting to get ‘round that she is willing to work with them.

All of this leads up to the realization that one day a week will no longer cut it and since the Medicaid thing is non-negotiable she ended up turning in her notice for the end of July. Her current clinic cuts over to insurance in August and her sticking around until July allows them time to try to find a replacement (good luck!). She also has 19 days of vacation to use before then so she’s using some of that to open additional days in her PP between now and August.

Daily Operations

So when she first started out her auto attendant had 4 options… 1) Patient messages, 2) patient refills, 3) new patients, and 4) Other providers/pharmacists. Options 1, 2, and 4 went to voicemail and option 3 said the voicemail box was full and directed them to her website where they could submit a new patient evaluation request via Luminello. We noticed that she was getting a decent amount of calls via Psychology Today and no evaluation requests. So I created a second auto attendant where option 3 is routed to her assistant (me) and she started getting a lot more requests once they could talk to someone.

I’ve become pretty good at converting calls to evaluation requests but even so the hit rate is probably only 20% or so. Most folks want to use their insurance so as a service I talk them through how to search their insurer’s physician lookup and tell them to start calling around. We’ve now started getting people coming back and signing up after calling around and not finding anyone. They always thank me for taking the time the first time around so I think of it as cheap marketing (all it takes is bit of my time).

She uses Luminello’s pre-screen evaluation requests to make the first decision on whether to start the new patient intake process. It has worked well for the most part. Once she accepts they get 7 forms (consent for treatment, office policy, credit card authorization, financial policy, blah blah blah) that they electronically sign through Luminello and a questionnaire (and maybe rating scales). We also have instructions on how to update demographics and add a credit card in the Luminello portal welcome message. No patients are scheduled without completing all of those items.

We send an e-mail after the paperwork is sent as sometimes the Luminello notification e-mails to them end up in spam. But even if she approves the eval and sends documentation a decent number of folks flake out before filling any of it out or halfway through. I can sometimes prod them info finishing and get them scheduled. So we’ve learned to not get excited when people send in requests or even start filling stuff out.

If you’re looking to have geri practice I don’t know that I’d use Luminello. Even without the pre-sceening it seems to screen out older patients all by itself. There have only been two 65+ folks who have made it all the way through the process and even after helping several through the process on the phone they never made it through to actually be scheduled. Which is fine by my wife as she has now decided to just keep it mostly to 60 and under. The younger crowd loves Luminello.

Since she took over a few patients from the cash pay doc who left practice she just adopted her pricing structure. It doesn’t necessarily make a ton of sense since follow ups are 33% more than new evals on a $/hr basis but we think that since she was in practice for 16 years she wasn’t really doing too many new evals. So when she raised her prices she must have raise the follow up rate and not bothered with new evals. The new eval rate is what my wife was planning to charge anyway and she does 1 hr for adults and 1.5 hrs for C&A.

Her one day a week is now starting to be consistently full two weeks out and we’re starting to fill some of those extra days. I think she’ll be able to make it to July without having to be more than a month out but it’ll be a close thing. She’s consistently getting 5-10 new referrals a week and since people are finding less availability in the area the new referrals seem to be picking up steam. She also now has 4 or 5 therapists that are unaffiliated with practices that have their own “prescribers” that are sending a lot of patients her way.

She has now begun informing her current patients at her main gig that she is leaving and many have said they will follow her. Some of them were transfers from the other doc, some of them know the reputation of the other doc, and others are just patients who want to stay with her. We’ll see how many actually follow through but it should be a decent amount as I can’t imagine they’ll find a replacement any time soon so there’s going to be a big crunch as the clinic can barely service the current volume as is.

Current patient load and financials to follow in next post…

 

[trophyhusband]

2020 – 8 patients and a loss of ($4,201.76)

2021 Q1 – 41 patients (11 C&A and 30 Adults) and a profit of $15,662.93 (before taxes)

2021 first 2 weeks of April – 6 new patients and room for 2 or 3 more.

Profit and Loss

September - December, 2020​

	SEP 2020​	OCT 2020​	NOV 2020​	DEC 2020​	TOTAL​
Income

Sales	0.00​	0.00​	1,850.00​	1,550.00​	$3,400.00​
Total Income	$0.00​	$0.00​	$1,850.00​	$1,550.00​	$3,400.00​
GROSS PROFIT	$0.00​	$0.00​	$1,850.00​	$1,550.00​	$3,400.00​

Expenses
Advertising & marketing	0.00​	0.00​	0.00​	350.00​	$350.00​

Listing fees	0.00​	29.95​	29.95​	29.95​	$89.85​
Total Advertising & marketing	0.00​	29.95​	29.95​	379.95​	$439.85​
Building & property rent	0.00​	514.94​	0.00​	250.00​	$764.94​

Business licences	99.14​	0.00​	0.00​	0.00​	$99.14​
EHR Expense	0.00​	0.00​	158.00​	99.00​	$257.00​

Insurance	0.00​	0.00​	0.00​	0.00​	$0.00​
Liability insurance	0.00​	0.00​	2,417.00​	0.00​	$2,417.00​

Total Insurance	0.00​	0.00​	2,417.00​	0.00​	$2,417.00​
Office expenses	1,769.11​	790.65​	0.00​	265.33​	$2,825.09​

Merchant account fees	0.00​	0.00​	0.00​	61.05​	$61.05​
Software & apps	12.00​	4.82​	35.50​	265.68​	$318.00​

Total Office expenses	1,781.11​	795.47​	35.50​	592.06​	$3,204.14​
Utilities	0.00​	0.00​	0.00​	0.00​	$0.00​

Internet & TV services	0.00​	219.69​	100.00​	100.00​	$419.69​
Total Utilities	0.00​	219.69​	100.00​	100.00​	$419.69​
Total Expenses	$1,880.25​	$1,560.05​	$2,740.45​	$1,421.01​	$7,601.76​

NET OPERATING INCOME	$ -1,880.25​	$ -1,560.05​	$ -890.45​	$128.99​	$ -4,201.76​
NET INCOME	$ -1,880.25​	$ -1,560.05​	$ -890.45​	$128.99​	$ -4,201.76​

Profit and Loss

January - March, 2021​

	JAN 2021​	FEB 2021​	MAR 2021​	TOTAL​
Income

Sales	6,100.00​	4,500.00​	9,700.00​	$20,300.00​
Total Income	$6,100.00​	$4,500.00​	$9,700.00​	$20,300.00​
GROSS PROFIT	$6,100.00​	$4,500.00​	$9,700.00​	$20,300.00​

Expenses
Advertising & marketing	376.80​	245.00​	0.00​	$621.80​

Listing fees	29.95​	29.95​	29.95​	$89.85​
Total Advertising & marketing	406.75​	274.95​	29.95​	$711.65​
Building & property rent	250.00​	250.00​	250.00​	$750.00​

Dues & subscriptions	175.00​	665.00​	0.00​	$840.00​
EHR Expense	99.00​	99.00​	100.00​	$298.00​

General business expenses	0.00​	0.00​	0.00​	$0.00​
Continuing education	0.00​	0.00​	905.00​	$905.00​

Total General business expenses	0.00​	0.00​	905.00​	$905.00​
Office expenses	148.74​	9.62​	0.00​	$158.36​

Merchant account fees	70.47​	240.15​	192.43​	$503.05​
Shipping & postage	4.25​	0.00​	0.00​	$4.25​

Software & apps	65.40​	50.68​	50.68​	$166.76​
Total Office expenses	288.86​	300.45​	243.11​	$832.42​
Utilities	0.00​	0.00​	0.00​	$0.00​

Internet & TV services	100.00​	100.00​	100.00​	$300.00​
Total Utilities	100.00​	100.00​	100.00​	$300.00​
Total Expenses	$1,319.61​	$1,689.40​	$1,628.06​	$4,637.07​

NET OPERATING INCOME	$4,780.39​	$2,810.60​	$8,071.94​	$15,662.93​
NET INCOME	$4,780.39​	$2,810.60​	$8,071.94​	$15,662.93​

 

[Sushirolls]

Off to a hell of a start. Your trajectory will be amazing. Well done, congratulations. I look forward to the future updates!
**Applause**

 

[medium rare]

Off to a hell of a start. Your trajectory will be amazing. Well done, congratulations. I look forward to the future updates!
**Applause**

Agreed. I’ve been running a thriving cash practice for 12 years now and you are off to a very sound start. Congratulations!

 

[clausewitz2]

Quick update re my practice so far: had a light month due to vagaries of insurance processing as I think I reported previously in April. Just got my revenue report from July, and my take of the gross was 26k, and based on current no-show rates and how full my schedule is until the end of the month, I expect revenue of about 9k weekly from the three days I am putting in every week. I could maximize this a bit more but I would rather incorporate a few therapy patients, work a tad longer, and see 12 total people in a day than see 16 f/us. Just a personal preference. I am in the strange situation where to make more doing private pay meds+therapy per hour than the insurance f/u's I would need to increase my rate significantly. If I actually put up a proper website and start advertising a bit for private therapy clients I am thinking $350 an hour minimum.

Maybe this all goes up in a puff of healthcare reform but for now the money is good out here. The big elephant in the room is what happens to telehealth reimbursement. It has been unambiguously a positive thing for my bottom line. The insurance industry for now does not seem to be mobilizing hard to push things back to the way they used to be and the administration seems to favor locking tele parity into place but who knows what will happen. I put my faith in the fact that there are enormous moneyed interests (i.e., every healthcare system and provider lobby out there) on the side of tele forever to get the job done.

EDIT: Agree very strongly about the geri population not being a great fit for luminello/tele so far. Older folks involved in tech seem to do fine with it (a lot of bipolar programmers in their 60s, for some reason) but anyone else struggles mightily. Most of them I just see on doxy.me because the URL never changes, but even this is confusing. I am still trying to socialize them to send a secure message to me instead of call, but this is a slow process. Thank God for doximity's straight-to-voicemail feature.

 

[Sushirolls]

That is phenomenal for your Net of 26k after the owner gross. Well done from the perspective of business growth. For others to put this in context, my year three Q1 (last quarter) was 50k gross, and ~32K net in my pocket - for a whole quarter!

 

[FlowRate]

I am in the strange situation where to make more doing private pay meds+therapy per hour than the insurance f/u's I would need to increase my rate significantly. If I actually put up a proper website and start advertising a bit for private therapy clients I am thinking $350 an hour minimum.

I was doing some back-of-the-napkin "what if I went cash PP" math recently and $350 is also what I came up with as the number I would shoot for and is actually not that much more than our HMO pays contracted external psychiatrists for 90792. It's also about what I would want to ensure I was making as much or more than my current total compensation seeing the same number of patients with conservative assumptions on collection/show/opening rate, overhead cost, and the cost/value of non-salary benefits.

 

[AD04]

I am in the strange situation where to make more doing private pay meds+therapy per hour than the insurance f/u's I would need to increase my rate significantly. If I actually put up a proper website and start advertising a bit for private therapy clients I am thinking $350 an hour minimum.

Good growth. You came a long way since January 2021. I think what you're doing (being aggressive with no-show fees, taking only high-paying insurances) is the right thing to do to make private practice worthwhile. This reduces no-show rate while maintaining your hourly rate if someone doesn't show up.

You're in a location that has at least 1 psychiatric residency. And most physicians tend to stay near where they trained. Any concerns about saturation in the future?

Any concerns about growth and increased administrative burden? Or has the psychologist held out his / her end of the bargain well?

 

[clausewitz2]

I was doing some back-of-the-napkin "what if I went cash PP" math recently and $350 is also what I came up with as the number I would shoot for and is actually not that much more than our HMO pays contracted external psychiatrists for 90792. It's also about what I would want to ensure I was making as much or more than my current total compensation seeing the same number of patients with conservative assumptions on collection/show/opening rate, overhead cost, and the cost/value of non-salary benefits.

I think lowballing that slightly could be good for building a client base in the first place but if that is less of a concern why not?

Good growth. You came a long way since January 2021. I think what you're doing (being aggressive with no-show fees, taking only high-paying insurances) is the right thing to do to make private practice worthwhile. This reduces no-show rate while maintaining your hourly rate if someone doesn't show up.

You're in a location that has at least 1 psychiatric residency. And most physicians tend to stay near where they trained. Any concerns about saturation in the future?

Any concerns about growth and increased administrative burden? Or has the psychologist held out his / her end of the bargain well?

There are two residencies in the area, actually. Until pretty recently people who trained at my program rarely stayed in the metro after graduation (my class of 14 residents had exactly one local). We'll see if that changes. The local health systems are massive and employ a lot of folks. I'm not super worried about saturation but there is a reason I am carving out a niche.

The psychologist has been as good as his word so far. I may need to start pushing for admin to take over prior auths but still manageable right now. Getting paid so far is as smooth as butter from my end, i really just answer secure messages, turn up to do the clinical work, write the notes, and am otherwise set.

 

[hebel]

Quick update re my practice so far: had a light month due to vagaries of insurance processing as I think I reported previously in April. Just got my revenue report from July, and my take of the gross was 26k, and based on current no-show rates and how full my schedule is until the end of the month, I expect revenue of about 9k weekly from the three days I am putting in every week. I could maximize this a bit more but I would rather incorporate a few therapy patients, work a tad longer, and see 12 total people in a day than see 16 f/us. Just a personal preference. I am in the strange situation where to make more doing private pay meds+therapy per hour than the insurance f/u's I would need to increase my rate significantly. If I actually put up a proper website and start advertising a bit for private therapy clients I am thinking $350 an hour minimum.

Maybe this all goes up in a puff of healthcare reform but for now the money is good out here. The big elephant in the room is what happens to telehealth reimbursement. It has been unambiguously a positive thing for my bottom line. The insurance industry for now does not seem to be mobilizing hard to push things back to the way they used to be and the administration seems to favor locking tele parity into place but who knows what will happen. I put my faith in the fact that there are enormous moneyed interests (i.e., every healthcare system and provider lobby out there) on the side of tele forever to get the job done.

EDIT: Agree very strongly about the geri population not being a great fit for luminello/tele so far. Older folks involved in tech seem to do fine with it (a lot of bipolar programmers in their 60s, for some reason) but anyone else struggles mightily. Most of them I just see on doxy.me because the URL never changes, but even this is confusing. I am still trying to socialize them to send a secure message to me instead of call, but this is a slow process. Thank God for doximity's straight-to-voicemail feature.

If you were to quantify it this way, how many wRVUs do you think you generated?

 

[justordinary]

If I want to open my own telepsych PP (work from home, use UPS address) then how would I be able to build up a patient load? do you suggest accepting some insurance and medicare and just get referrals from insurance companies? It would be harder to market for telepsych, I assume...

 

[InvestingDoc]

2020 – 8 patients and a loss of ($4,201.76)

2021 Q1 – 41 patients (11 C&A and 30 Adults) and a profit of $15,662.93 (before taxes)

2021 first 2 weeks of April – 6 new patients and room for 2 or 3 more.

Profit and Loss

September - December, 2020​

	SEP 2020​	OCT 2020​	NOV 2020​	DEC 2020​	TOTAL​
Income

Sales	0.00​	0.00​	1,850.00​	1,550.00​	$3,400.00​
Total Income	$0.00​	$0.00​	$1,850.00​	$1,550.00​	$3,400.00​
GROSS PROFIT	$0.00​	$0.00​	$1,850.00​	$1,550.00​	$3,400.00​

Expenses
Advertising & marketing	0.00​	0.00​	0.00​	350.00​	$350.00​

Listing fees	0.00​	29.95​	29.95​	29.95​	$89.85​
Total Advertising & marketing	0.00​	29.95​	29.95​	379.95​	$439.85​
Building & property rent	0.00​	514.94​	0.00​	250.00​	$764.94​

Business licences	99.14​	0.00​	0.00​	0.00​	$99.14​
EHR Expense	0.00​	0.00​	158.00​	99.00​	$257.00​

Insurance	0.00​	0.00​	0.00​	0.00​	$0.00​
Liability insurance	0.00​	0.00​	2,417.00​	0.00​	$2,417.00​

Total Insurance	0.00​	0.00​	2,417.00​	0.00​	$2,417.00​
Office expenses	1,769.11​	790.65​	0.00​	265.33​	$2,825.09​

Merchant account fees	0.00​	0.00​	0.00​	61.05​	$61.05​
Software & apps	12.00​	4.82​	35.50​	265.68​	$318.00​

Total Office expenses	1,781.11​	795.47​	35.50​	592.06​	$3,204.14​
Utilities	0.00​	0.00​	0.00​	0.00​	$0.00​

Internet & TV services	0.00​	219.69​	100.00​	100.00​	$419.69​
Total Utilities	0.00​	219.69​	100.00​	100.00​	$419.69​
Total Expenses	$1,880.25​	$1,560.05​	$2,740.45​	$1,421.01​	$7,601.76​

NET OPERATING INCOME	$ -1,880.25​	$ -1,560.05​	$ -890.45​	$128.99​	$ -4,201.76​
NET INCOME	$ -1,880.25​	$ -1,560.05​	$ -890.45​	$128.99​	$ -4,201.76​

Profit and Loss

January - March, 2021​

	JAN 2021​	FEB 2021​	MAR 2021​	TOTAL​
Income

Sales	6,100.00​	4,500.00​	9,700.00​	$20,300.00​
Total Income	$6,100.00​	$4,500.00​	$9,700.00​	$20,300.00​
GROSS PROFIT	$6,100.00​	$4,500.00​	$9,700.00​	$20,300.00​

Expenses
Advertising & marketing	376.80​	245.00​	0.00​	$621.80​

Listing fees	29.95​	29.95​	29.95​	$89.85​
Total Advertising & marketing	406.75​	274.95​	29.95​	$711.65​
Building & property rent	250.00​	250.00​	250.00​	$750.00​

Dues & subscriptions	175.00​	665.00​	0.00​	$840.00​
EHR Expense	99.00​	99.00​	100.00​	$298.00​

General business expenses	0.00​	0.00​	0.00​	$0.00​
Continuing education	0.00​	0.00​	905.00​	$905.00​

Total General business expenses	0.00​	0.00​	905.00​	$905.00​
Office expenses	148.74​	9.62​	0.00​	$158.36​

Merchant account fees	70.47​	240.15​	192.43​	$503.05​
Shipping & postage	4.25​	0.00​	0.00​	$4.25​

Software & apps	65.40​	50.68​	50.68​	$166.76​
Total Office expenses	288.86​	300.45​	243.11​	$832.42​
Utilities	0.00​	0.00​	0.00​	$0.00​

Internet & TV services	100.00​	100.00​	100.00​	$300.00​
Total Utilities	100.00​	100.00​	100.00​	$300.00​
Total Expenses	$1,319.61​	$1,689.40​	$1,628.06​	$4,637.07​

NET OPERATING INCOME	$4,780.39​	$2,810.60​	$8,071.94​	$15,662.93​
NET INCOME	$4,780.39​	$2,810.60​	$8,071.94​	$15,662.93​

This is amazing, keep up the good work!

 

[trophyhusband]

Here's the Q2 update. Items of note:

• 73 Active patients though 3 of these are not sure they'll be remaining in state so they may drop off.
• Lost 3 or 4 patients from the last update. 2 or 3 never scheduled after the first appointment which isn't surprising since they graduated and we're sure if they were staying in state. 1 was a drug seeker who kept asking for controlled substances but never got any and eventually saw in the state Rx database he was in rehab and never came back after that.
• June was very slow for new patients which is not a big surprise with school (both municipal and university) being out of session. Also took a week vacation and it was nice not having to worry about missing referrals much at all. Expect big up swing at the end of July into August.
• Still a decent amount of folks are sending in requests to be seen and fill out all the paperwork but never add a credit card and then disappear. Not sure if they think they'll sneak by or what but her initial welcome e-mail clearly states that no appointment will be scheduled without all paperwork and a credit card added to her patient portal. Not really a big deal but it taught us quickly to not get excited about any particular new patient who submits an initial request.
• Psychology Today and a couple of therapists are still the big sources of new patients. Starting to get more from a couple of other sources and once she's no longer working the second job starting in August she'll make some stops at referral offices.
• University has a healthcare section in their student newspaper so she's going to buy an advertising spot there and see if anything comes of it. 2 new patients initial visits would pay for the entire cost so it's worth a shot.
• Had to buy a new cell phone because the old one was dying and the accountant recommended she expense it to the business.
• Switched over to the yearly subscription for Luminello to avoid the 20% increase but they still haven't charged the fee for the year for reasons that remain mysterious. She did pay $600 to get the state drug database integrated into Luminello which is a big time saver and totally worth the cost to her.
• We updated the withholdings on her current position for the last 3 months of her employment to make sure she maxes out her 2 retirement accounts at $19.5k and with her employer contribution that'll put her at around $50k for the year. We'll see how the rest of the year goes but we're not planning to open a solo-401k until next year but if things really take off it will be a consideration.

Financials to follow in next post.

 

[trophyhusband]

Profit and Loss by Month
January - June, 2021
	Jan 2021	Feb 2021	Mar 2021	Apr 2021	May 2021	Jun 2021	Total
Income
Sales	5,800.00	4,300.00	9,400.00	6,650.00	8,550.00	7,000.00	41,700.00
Total Income	$ 5,800.00	$ 4,300.00	$ 9,400.00	$ 6,650.00	$ 8,550.00	$ 7,000.00	$ 41,700.00
Gross Profit	$ 5,800.00	$ 4,300.00	$ 9,400.00	$ 6,650.00	$ 8,550.00	$ 7,000.00	$ 41,700.00
Expenses
Advertising & marketing	376.80	245.00	0.00	0.00	0.00	0.00	621.80
Listing fees	29.95	29.95	29.95	29.95	29.95	29.95	179.70
Total Advertising & marketing	$ 406.75	$ 274.95	$ 29.95	$ 29.95	$ 29.95	$ 29.95	$ 801.50
Building & property rent	250.00	250.00	250.00	250.00	250.00	250.00	1,500.00
Dues & subscriptions	175.00	665.00	0.00	0.00	0.00	0.00	840.00
EHR Expense	99.00	99.00	100.00	0.00	0.00	600.00	898.00
General business expenses	0.00	0.00	0.00	0.00	0.00	0.00	0.00
Continuing education	0.00	0.00	905.00	0.00	0.00	0.00	905.00
Total General business expenses	$ 0.00	$ 0.00	$ 905.00	$ 0.00	$ 0.00	$ 0.00	$ 905.00
Legal & accounting services	0.00	0.00	0.00	0.00	0.00	0.00	0.00
Accounting fees	0.00	0.00	0.00	450.00	0.00	0.00	450.00
Total Legal & accounting services	$ 0.00	$ 0.00	$ 0.00	$ 450.00	$ 0.00	$ 0.00	$ 450.00
Office expenses	148.74	9.62	0.00	0.00	71.60	136.93	366.89
Merchant account fees	70.47	240.15	192.43	317.65	292.54	296.37	1,409.61
Office supplies	0.00	0.00	0.00	0.00	0.00	802.49	802.49
Shipping & postage	4.25	0.00	0.00	0.00	0.00	0.00	4.25
Software & apps	65.40	50.68	50.68	50.83	63.33	63.34	344.26
Total Office expenses	$ 288.86	$ 300.45	$ 243.11	$ 368.48	$ 427.47	$ 1,299.13	$ 2,927.50
Taxes paid	0.00	0.00	0.00	3,275.00	0.00	0.00	3,275.00
Utilities	0.00	0.00	0.00	0.00	0.00	0.00	0.00
Internet & TV services	100.00	100.00	100.00	100.00	100.00	100.00	600.00
Total Utilities	$ 100.00	$ 100.00	$ 100.00	$ 100.00	$ 100.00	$ 100.00	$ 600.00
Total Expenses	$ 1,319.61	$ 1,689.40	$ 1,628.06	$ 4,473.43	$ 807.42	$ 2,279.08	$ 12,197.00
Net Operating Income	$ 4,480.39	$ 2,610.60	$ 7,771.94	$ 2,176.57	$ 7,742.58	$ 4,720.92	$ 29,503.00
Net Income	$ 4,480.39	$ 2,610.60	$ 7,771.94	$ 2,176.57	$ 7,742.58	$ 4,720.92	$ 29,503.00

 

[Sushirolls]

I love that rent price! **$250.00**

I've opted not for the integrated controlled substance database, because I'm so used to using the external and fast at it, I couldn't justify their integration fee.

 

[trophyhusband]

I love that rent price! **$250.00**

It's about to go up 3%! Talk about a backbreaker. It is pretty amazing and it's actually fairly nice but when she rented it her intention was to only be seeing CAP patients 1/2 day on the weekends so it was reasonable for the income that would have produced.

Then all the other Psychiatrists left town and now it's just ridiculous for what this practice will probably eventually produce. She's planning to stay for her full 3 year option period because why not? All of the patients are already used to it so no point in moving right now.

 

[Sushirolls]

Recently I looked over a few years tax returns. Positively the accountants I have used, put down effective tax rates and marginal tax rate. The difference between marginal tax rate and effective tax rate is an interesting thing to wrap your head around. Didn't really pay much attention until recently. The past few years with my income entirely coming from a schedule C, sole proprietor, pass thru organization I've been able to see the nuances of deductions and credits and where things are entered on the forms and how they impact your AGI and ultimately the final tax owed. Getting a little better understanding of where these all get entered, thanks to the well done summaries of accountants, I attempted to extrapolate.

The point is, the bigger income I had years ago was taxed higher, and if I hit the same income, my taxation will be a little bit less relatively speaking. This means I can spin the hamster wheel less than what I had to years ago for the same amount of cheese reward simply because of the more favorable taxation of LLC setups. This makes me happy. I know I'm not articulating this well, but seeing real numbers and projections further helped add more evidence to the Pros column in the pros/cons of opening one's own private practice.

 

[Jules A]

Hopefully this is allowed and I do not have any financial interest although I have used David's service. The website isn't especially high tech but his advice and knowledge are solid in my opinion. For those who are comfortable doing their own financial planning this is a physician who is a financial advisor and does fee for service on an hourly basis. The big pluses here is #1 he's a physician and also for those who aren't familiar with the whole financial advisor world many, most?, want to take control of all your investments-pros and cons to that for sure but I'm happy managing my own finances and just need advice from time to time. For business owners there are retirement vehicles etc. that provide significant benefits if you know about them and how to use them.

About FiPhysician – FiPhysician

www.fiphysician.com

 

[Sushirolls]

Couldn't delay for end of year to post this kernel:
Finally switched away from Big Telecom to do all in on Google Voice.
I have a google voice number assigned to me, which is used for the 'on call' after hours issues.
Assistant is assigned the main office number now.

Issue is how do I get those transcribed voicemails that go the assistants email, (when out of the office), as mine is still currently part time? Or if out sick or on vacation?
I thought about upgrading to Google Voice Standard, briefly did, and was playing around with Auto Attendant and even the Group Ring feature.
But before I delved into those, and the increased costs associated with that, I realized a simpler solution.

Assistant email is now set up with a filter that forwards (copies) all the transcribed voicemails to my email too. Thankfully these are all within the google business sphere - so no HIPAA issues, i.e. all internal to the business network.
I created a filter in my own email where these then dump into a special folder immediately, and bypass the inbox (avoiding any push notifications on my cell phone).
So if, and when, I choose, I can look at that special folder to view the office voicemails.
~$10-12 per phone line.

This solution and change has me all excited! So glad to be away from the Big Telecom. And yes it was just as painful as I thought to cut the cord from them, too.

 

[trophyhusband]

Couldn't delay for end of year to post this kernel:
Finally switched away from Big Telecom to do all in on Google Voice.
I have a google voice number assigned to me, which is used for the 'on call' after hours issues.
Assistant is assigned the main office number now.

Issue is how do I get those transcribed voicemails that go the assistants email, (when out of the office), as mine is still currently part time? Or if out sick or on vacation?
I thought about upgrading to Google Voice Standard, briefly did, and was playing around with Auto Attendant and even the Group Ring feature.
But before I delved into those, and the increased costs associated with that, I realized a simpler solution.

Assistant email is now set up with a filter that forwards (copies) all the transcribed voicemails to my email too. Thankfully these are all within the google business sphere - so no HIPAA issues, i.e. all internal to the business network.
I created a filter in my own email where these then dump into a special folder immediately, and bypass the inbox (avoiding any push notifications on my cell phone).
So if, and when, I choose, I can look at that special folder to view the office voicemails.
~$10-12 per phone line.

This solution and change has me all excited! So glad to be away from the Big Telecom. And yes it was just as painful as I thought to cut the cord from them, too.

One of the first things we signed up for was the Google Voice auto attendant feature and it works wonderfully. We have two set up one for during the week and one for the weekend or when we're on vacation. We set up 4 options:

1. Existing patient refills. Goes to voicemail.
2. Existing patient concerns or questions. Goes to voicemail.
3. New patient consultations. During the week it rings to my cell phone. When the other auto attendant is on it says that she is accepting new patients but voice mailbox is full and to go to her website to fill out a new consultation request.
4. Provider/pharmacy mailbox.

It works wonderfully and we actually get a decent number of consultation requests over the weekends so I think it's working. It does not use one of your existing numbers though so you'll have to change the number on your website/Google My Business/Psychology Today/etc to get it to work. We've had it set up this way from the start so it wasn't an issue.

Main thing is that you have to remember to manually switch the phone number between the two attendants. It's just a few clicks but occasionally I forget to do it so I end up chatting with a potential patient or two on the weekend .

 

[Sushirolls]

... It does not use one of your existing numbers though so you'll have to change the number on your website/Google My Business/Psychology Today/etc to get it to work...

If I'm understanding you correctly, you upgraded from the lower package, starter, to the standard to get this auto attendant feature, and in doing so you couldn't use existing google voice numbers in your account. Google Voice requires you to use a new fresh number to be the designated auto attendant line?

 

[trophyhusband]

If I'm understanding you correctly, you upgraded from the lower package, starter, to the standard to get this auto attendant feature, and in doing so you couldn't use existing google voice numbers in your account. Google Voice requires you to use a new fresh number to be the designated auto attendant line?

So we signed up for a Google Voice number first and then later signed up for Google Workspace. The Google Voice number integrated into the Workspace platform where we built the auto attendant (it's under the Google Voice app which is what I guess you mean as the upgrade) but you cannot assign the regular GV number to it. We had to get a new number to assign to the attendant.

Hopefully that made sense. Basically, in the GV app on Workspace I can see both numbers but the only one that can be assigned to either of the attendants is the one we got specifically for that purpose.

 

[Sushirolls]

Bad Debt, money not collected.

Any one know how this should be looked at more formally? Trying to process the numbers I've got and would like to have a more standard uniform review of this data point as time marches on.

So far I'm thinking of just taking the sum total dollar value of money that was supposed to be collected, but didn't, for a whole year and dividing it by the gross income of the year to ultimately get a percentage.
((Bad Debt) / (Gross Income)) * 100 = Percentage Bad Debt

Or...

Should the formula be:
((Bad Debt) / (Bad Debt + Gross Income)) * 100 = Percentage Bad Debt

Or...

Some other way?

 

[trophyhusband]

Bad Debt, money not collected.

Any one know how this should be looked at more formally? Trying to process the numbers I've got and would like to have a more standard uniform review of this data point as time marches on.

So far I'm thinking of just taking the sum total dollar value of money that was supposed to be collected, but didn't, for a whole year and dividing it by the gross income of the year to ultimately get a percentage.
((Bad Debt) / (Gross Income)) * 100 = Percentage Bad Debt

Or...

Should the formula be:
((Bad Debt) / (Bad Debt + Gross Income)) * 100 = Percentage Bad Debt

Or...

Some other way?

Gotta include it in the numerator and the denominator.

 

[Sushirolls]

Doing the formula:
((Bad Debt) / (Bad Debt + Gross Income)) * 100 = Percentage Bad Debt

For the 2020 year, was 1.9% or conversely I had a 98.1% collection rate. I think that is really good?

 

[Bartelby]

98.1 percent seems great! I'm not sure what typical numbers are but it can't get too much higher.

 

[Liquid8]

Doing the formula:
((Bad Debt) / (Bad Debt + Gross Income)) * 100 = Percentage Bad Debt

For the 2020 year, was 1.9% or conversely I had a 98.1% collection rate. I think that is really good?

Have struggled with organising these figures as well. Every so often my accounts person will email me about outstanding debts over 90-120 days, but as a percentage of gross income it’s still low (< 0.5%), and usually she’ll call them up to work out what’s going on. When contacted often people haven’t realised and do make an effort settle their accounts, so I do give some leeway about late payments. Otherwise, my standard response now is to not allow any further bookings until current debts. If someone hasn’t booked any future appointments and completely drops off the radar/can’t be contacted, it’s safe to assume they’re not coming back. Here we can opt to have the rebates processed (and at least get something for my work), but keep the outstanding amounts owed on file as a reminder.

What has happened a few times is that they get re-referred some years later – accepting this is at my discretion, and unfortunately for patients I’ve been keeping more detailed notes about this kind of thing. They’ll still have to pay any amounts owing, but I’ll give a second chance to patients I remember as being nice or had a good reason for disappearing, as opposed to ones who are more anti-social, sketchy or have missed more than 1 appointment. Can remember one who lied to my staff saying I called her to waive her fees, so that was a very easy decision to decline.

At some point I did accept that there will always be bad debt and screening processes aren't ever going to be perfect. Referring to debt collection services is always an option, but not one I’ve used when weighing up the risks of antagonism and potential hits to reputation etc. Here patients probably don’t realise this, but the reality is that it is very difficult to get into see a psychiatrist, and less so for anyone that screams personality/BPD/ADHD - so if they want to take their chances elsewhere it’s not my place to tell them otherwise.

 

[Jules A]

Have struggled with organising these figures as well. Every so often my accounts person will email me about outstanding debts over 90-120 days, but as a percentage of gross income it’s still low (< 0.5%), and usually she’ll call them up to work out what’s going on. When contacted often people haven’t realised and do make an effort settle their accounts, so I do give some leeway about late payments. Otherwise, my standard response now is to not allow any further bookings until current debts. If someone hasn’t booked any future appointments and completely drops off the radar/can’t be contacted, it’s safe to assume they’re not coming back. Here we can opt to have the rebates processed (and at least get something for my work), but keep the outstanding amounts owed on file as a reminder.

What has happened a few times is that they get re-referred some years later – accepting this is at my discretion, and unfortunately for patients I’ve been keeping more detailed notes about this kind of thing. They’ll still have to pay any amounts owing, but I’ll give a second chance to patients I remember as being nice or had a good reason for disappearing, as opposed to ones who are more anti-social, sketchy or have missed more than 1 appointment. Can remember one who lied to my staff saying I called her to waive her fees, so that was a very easy decision to decline.

At some point I did accept that there will always be bad debt and screening processes aren't ever going to be perfect. Referring to debt collection services is always an option, but not one I’ve used when weighing up the risks of antagonism and potential hits to reputation etc. Here patients probably don’t realise this, but the reality is that it is very difficult to get into see a psychiatrist, and less so for anyone that screams personality/BPD/ADHD - so if they want to take their chances elsewhere it’s not my place to tell them otherwise.

And may actually be worth eating the cost of one med check.

 

[Sushirolls]

Otherwise, my standard response now is to not allow any further bookings until current debts.

I recall you are Australian?

As nice as this is from a business point to increase collections, I don't believe we can do this in the US. I forgot who laid this down if medical boards, or professional societies. We have to continue to provide care even if no payment. We can also simply terminate care with dutiful notice of time and emergency coverage, but we can't with hold for non-payment.

 

[TexasPhysician]

I recall you are Australian?

As nice as this is from a business point to increase collections, I don't believe we can do this in the US. I forgot who laid this down if medical boards, or professional societies. We have to continue to provide care even if no payment. We can also simply terminate care with dutiful notice of time and emergency coverage, but we can't with hold for non-payment.

It may depend on the state, but this is perfectly fine where I practice. I’m not an ER. EMTALA doesn’t apply. I can’t withhold records for non-payment, but nothing says I must provide free care to my knowledge.

 

[VA Hopeful Dr]

It may depend on the state, but this is perfectly fine where I practice. I’m not an ER. EMTALA doesn’t apply. I can’t withhold records for non-payment, but nothing says I must provide free care to my knowledge.

Same here

 

[Sushirolls]

It may depend on the state, but this is perfectly fine where I practice. I’m not an ER. EMTALA doesn’t apply. I can’t withhold records for non-payment, but nothing says I must provide free care to my knowledge.

So let's say some one has GAD and MDD, some response, no remission, on say 150mg of Effexor XR, Trazdone 100mg HS. Has had initial consult, and 2 previous follow ups. Not paid for any of the out of pocket expenses. Currently owes ~$100-300.

Can you then say, sorry, you will not be rescheduled nor have any refills until you pay up?
I think it was in PRITE, licensing exams, and even in board certification that basically says you got to see the patients and do refills othewise it could be considered patient abandonment. The only real exit is to do a 30 day termination, provide refills, and in the letter of termination point in direction where continued care could be sought. And you are on the hook for an emergency care needs/assessments for that 30 day period. I.e. Patient calls office "I'm in crisis and wondering about hurting myself but no plan/intent."

 

[TexasPhysician]

So let's say some one has GAD and MDD, some response, no remission, on say 150mg of Effexor XR, Trazdone 100mg HS. Has had initial consult, and 2 previous follow ups. Not paid for any of the out of pocket expenses. Currently owes ~$100-300.

Can you then say, sorry, you will not be rescheduled nor have any refills until you pay up?
I think it was in PRITE, licensing exams, and even in board certification that basically says you got to see the patients and do refills othewise it could be considered patient abandonment. The only real exit is to do a 30 day termination, provide refills, and in the letter of termination point in direction where continued care could be sought. And you are on the hook for an emergency care needs/assessments for that 30 day period. I.e. Patient calls office "I'm in crisis and wondering about hurting myself but no plan/intent."

Requiring payment is not abandonment. Alternatively you can send in 1 refill and terminate through your policies. Continuing to Rx Effexor is not a requirement without properly following up. You are also legally on the hook if the patient overdoses on Effexor if you continue to fill every month without checking in on benefit in an appropriate manner.

 

[calvnandhobbs68]

So let's say some one has GAD and MDD, some response, no remission, on say 150mg of Effexor XR, Trazdone 100mg HS. Has had initial consult, and 2 previous follow ups. Not paid for any of the out of pocket expenses. Currently owes ~$100-300.

Can you then say, sorry, you will not be rescheduled nor have any refills until you pay up?
I think it was in PRITE, licensing exams, and even in board certification that basically says you got to see the patients and do refills othewise it could be considered patient abandonment. The only real exit is to do a 30 day termination, provide refills, and in the letter of termination point in direction where continued care could be sought. And you are on the hook for an emergency care needs/assessments for that 30 day period. I.e. Patient calls office "I'm in crisis and wondering about hurting myself but no plan/intent."

Yes, so basically the out is the termination with 30 days of refills/continuing care until then. However, 1 appointment would be considered pretty reasonable continuing care, they can't be calling you up every week demanding a weekly therapy appointment or something when they're $300 behind and not paying anything. Otherwise, they're welcome to go to the ER.

Typically most clinics I've seen say in the patient financial agreement that they sign that they aren't allowed to get X dollar amount or X number of visits behind or else they won't keep scheduling them appointments until they're on a payment plan. If a patient signs this upfront, they'd be hard pressed to say they've been "abandoned" later on down the line. For instance I think my clinic right now it's $200 behind before you have to be put on a payment plan or they won't keep scheduling you appointments that all the patients sign on their intake paperwork.

 

[allantois]

I worked at a place that would not release records if patients had a balance on the account

 

[WisNeuro]

I worked at a place that would not release records if patients had a balance on the account

If this is in the US, I do not believe that is legal.

 

[allantois]

If this is in the US, I do not believe that is legal.

This is in US; I remember this was in our intake paperwork

 

[WisNeuro]

This is in US; I remember this was in our intake paperwork

How many times has this place been sued? You can charge for reasonable costs for copying and mailing records, but you cannot withhold records for lack of payment. Well, unless you want a significant fine and possible loss of licensure.

 

[Bartelby]

You can't refuse to release records for nonpayment: What should I do if my doctor does not give me access to my records? | HealthIT.gov

 

[calvnandhobbs68]

If this is in the US, I do not believe that is legal.

Yeahhh that's actually illegal. lol @Bartelby beat me to the link.

 

[WisNeuro]

And, if they actually put that provision formally into their intake paperwork, they provided explicit evidence of their own illegality. How has a provider using these intake forms not pointed this out yet? If you are the one getting the patient to sign this, I'd have to imagine you are putting yourself at some level of liability as well.

Note to people out there, it's always a good idea to have a lawyer with healthcare experience look over your legal patient paperwork (e.g. consent forms, payment agreements, etc).

 

[trophyhusband]

You can't refuse to release records for nonpayment: What should I do if my doctor does not give me access to my records? | HealthIT.gov

This is a HIPAA rule, if you don't take insurance it doesn't apply. You'd have to follow your state's guidance. I'd guess most states have something similar but there may be some that do not.

 

[WisNeuro]

This is a HIPAA rule, if you don't take insurance it doesn't apply. You'd have to follow your state's guidance. I'd guess most states have something similar but there may be some that do not.

I believe that there are both federal and state laws that still maintain that you cannot withhold a patient's records for non-payment, even with cash pay. Especially if they transmit PHI in an electronic format. If this is not the case, I'd love to see the appropriate statutes that exempt cash pay healthcare providers.

 

[Bartelby]

I could be wrong but I believe as Wisneuro mentioned that if you transmit data electronically HIPAA applies to your practice, even if you don't take insurance.

 

[trophyhusband]

I could be wrong but I believe as Wisneuro mentioned that if you transmit data electronically HIPAA applies to your practice, even if you don't take insurance.

Only if you submit claims data electronically to an insurer. So if you send the patient a superbill via e-mail or patient portal you're not a covered entity. If you send the claim for them to their insurer via fax or clearinghouse you are a covered entity.

 

[trophyhusband]

I believe that there are both federal and state laws that still maintain that you cannot withhold a patient's records for non-payment, even with cash pay. Especially if they transmit PHI in an electronic format. If this is not the case, I'd love to see the appropriate statutes that exempt cash pay healthcare providers.

See my reply above and sorry but I'm not looking through the statutes for 50 different states to see if every one of them has similar language to HIPAA.

 

[WisNeuro]

Only if you submit claims data electronically to an insurer. So if you send the patient a superbill via e-mail or patient portal you're not a covered entity. If you send the claim for them to their insurer via fax or clearinghouse you are a covered entity.

If you use certain businesses to assist you in your practice, I believe you are also a covered entity. Regardless, I would be very surprised to see any state without applicable laws. So, I call BS on this claim for the moment. There is a claim that this exists somewhere, so I'm curious where this exists. IF you are not aware of a specific instance, how can you make this claim?

 

[trophyhusband]

If you use certain businesses to assist you in your practice, I believe you are also a covered entity. Regardless, I would be very surprised to see any state without applicable laws. So, I call BS on this claim for the moment. There is a claim that this exists somewhere, so I'm curious where this exists. IF you are not aware of a specific instance, how can you make this claim?

The businesses that assist you are the clearinghouses I referred to so yes if you submit your claim through a clearinghouse or if your biller does that makes you a covered entity.

I'm not making any claim. I'm just saying it's not for sure illegal like was implied above. I doubt any state has a statute that explicitly denies someone the right to their medical records but does every state have a statute that explicitly states that you have the right to your medical records and under what timeframe? I do not know the answer. I wouldn't assume they all do though.