Private Practice Olio

[Sanman]

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I've decided it's best to focus on one thing instead of too many disparate things I don't do as well at. Looking at a combo assessment/therapy practice. Still quite anxious about jumping ship from the VA. Worried about things like consistent referrals, insurance clawbacks, and how to plan for retirement (going to meet with a financial adviser). But the flexibility seems so amazing compared to having to put in 15 minutes of leave when there's a massive snowstorm & I can't get here on time.

1. Definitely agree it is best to focus on one thing at a time if you want to get it right. Even in building a PP, build out the therapy portion, sort your referrals, get your business setup properly. Then focus on adding assessment or additional services.

2. Your leadership seems like a pain. My local timecard people won't even process a 15 min leave.

 

[PsynofTimes]

1. Definitely agree it is best to focus on one thing at a time if you want to get it right. Even in building a PP, build out the therapy portion, sort your referrals, get your business setup properly. Then focus on adding assessment or additional services.

2. Your leadership seems like a pain. My local timecard people won't even process a 15 min leave.

It is a pain. I wish they treated us like actual adults. I mean I get it because some people AREN'T adults, but I get tired of the nickel and diming on patient care and time. They should just have us punch in.

 

[PsynofTimes]

Does anyone have a ballpark number for what a good insurance plan like BCBS will reimburse for ADHD assessment consisting of clinical interview, testing, and report writing? I know that's not an easy question to answer, but wondering if there's any general feedback.

 

[AcronymAllergy]

Does anyone have a ballpark number for what a good insurance plan like BCBS will reimburse for ADHD assessment consisting of clinical interview, testing, and report writing? I know that's not an easy question to answer, but wondering if there's any general feedback.

It's going to be heavily dependent on how long the entire process takes you; almost impossible to answer without that information, unfortunately.

Also, "testing" can be pretty variable. You're not always able to bill for administration time of self-report measures, for example.

 

[WisNeuro]

Does anyone have a ballpark number for what a good insurance plan like BCBS will reimburse for ADHD assessment consisting of clinical interview, testing, and report writing? I know that's not an easy question to answer, but wondering if there's any general feedback.

Need to check your local BCBS policy, ours is fairly limiting for ADHD evals.

 

[PsyDr]

I've decided it's best to focus on one thing instead of too many disparate things I don't do as well at. Looking at a combo assessment/therapy practice. Still quite anxious about jumping ship from the VA. Worried about things like consistent referrals, insurance clawbacks, and how to plan for retirement (going to meet with a financial adviser). But the flexibility seems so amazing compared to having to put in 15 minutes of leave when there's a massive snowstorm & I can't get here on time.

1) I think this approach is wise. However, you shouldn't avoid things due to a lack of mastery. You achieve mastery by repetitively doing a task.

2) While waiting is wise, I'd point out that you're focusing on VERY infrequent things.
a. Referrals: How often have you heard of a therapist without a wait list? That should tell you something about referrals.
b. Insurance clawbacks: I've had exactly two instances, ever.

3) I would highly recommend planning your retirement using Firecalc. Input your stuff. Google terms you don't know. Keep playing with it until you can make sense of the subject matter. There are other retirement planning things, but few better.

 

[PsynofTimes]

1) I think this approach is wise. However, you shouldn't avoid things due to a lack of mastery. You achieve mastery by repetitively doing a task.

2) While waiting is wise, I'd point out that you're focusing on VERY infrequent things.
a. Referrals: How often have you heard of a therapist without a wait list? That should tell you something about referrals.
b. Insurance clawbacks: I've had exactly two instances, ever.

3) I would highly recommend planning your retirement using Firecalc. Input your stuff. Google terms you don't know. Keep playing with it until you can make sense of the subject matter. There are other retirement planning things, but few better.

Thank you for this advice. I have so much anxiety about leaving the certainty behind, so it's reassuring to hear that there aren't too many insurance clawbacks. Therapy seems to be in high demand, and I'm a good therapist, so I think I'll be ok, but it does take some time to build & then wait for insurance reimbursements. Thank you for the advice on Firecalc.

 

[PsynofTimes]

It does appear that insurance is fairly limited on what it covers for ADHD evals unless there is another diagnosis. Seems odd. If the person only has ADHD, which I understand is rare but not impossible, the insurance won't pay based on the diagnosis? Seems crazy.

 

[WisNeuro]

It does appear that insurance is fairly limited on what it covers for ADHD evals unless there is another diagnosis. Seems odd. If the person only has ADHD, which I understand is rare but not impossible, the insurance won't pay based on the diagnosis? Seems crazy.

Hasn't been my experience that they won't pay, rather they won't pay for neuropsych testing codes and won't pay for a an unnecessary number of psych testing codes

 

[PsynofTimes]

Hasn't been my experience that they won't pay, rather they won't pay for neuropsych testing codes and won't pay for a an unnecessary number of psych testing codes

Oh ok thank you. I think the biller is confused between psych testing and neuropsych testing.

 

[WisNeuro]

Oh ok thank you. I think the biller is confused between psych testing and neuropsych testing.

They commonly are. If this is something you plan on doing regularly, you should definitely pull the insurer's psych/neuropsych testing policies and know them well. It will potentially save you a lot of time and money on the back end.

 

[PsynofTimes]

They commonly are. If this is something you plan on doing regularly, you should definitely pull the insurer's psych/neuropsych testing policies and know them well. It will potentially save you a lot of time and money on the back end.

Thank you for this advice!

 

[PsyDr]

It does appear that insurance is fairly limited on what it covers for ADHD evals unless there is another diagnosis. Seems odd. If the person only has ADHD, which I understand is rare but not impossible, the insurance won't pay based on the diagnosis? Seems crazy.

1) That is HIGHLY dependent on the specific insurance policy. There is zero coherence between plans, even under the same insurance company. Medicare might pay for all testing. "ACME Bronze Plus of Random State" might not pay for any psych testing for conditions they don't cover, but "ACME Emerald Plus of Random State" might only pay for 2 units of testing. Reading the provider handbook takes some time, but it is pretty easy to do. Some insurance companies require you to take all their policies, but you can schedule limited availability for that policy.

2) Your NPI taxonomy might affect your ability to get reimbursed. Make sure that your NPI taxonomy matches the other testers in your area.

3) Money: I would HIGHLY recommend that you keep significant cash reserves in your business account. Let's say you net $150k your first year, and you pay yourself $90k. With that kind of backing, you can easily withstand the highs and lows of practice. If it builds up, there are ways to pay yourself a dividend.

 

[AcronymAllergy]

1) That is HIGHLY dependent on the specific insurance policy. There is zero coherence between plans, even under the same insurance company. Medicare might pay for all testing. "ACME Bronze Plus of Random State" might not pay for any psych testing for conditions they don't cover, but "ACME Emerald Plus of Random State" might only pay for 2 units of testing. Reading the provider handbook takes some time, but it is pretty easy to do. Some insurance companies require you to take all their policies, but you can schedule limited availability for that policy.

2) Your NPI taxonomy might affect your ability to get reimbursed. Make sure that your NPI taxonomy matches the other testers in your area.

3) Money: I would HIGHLY recommend that you keep significant cash reserves in your business account. Let's say you net $150k your first year, and you pay yourself $90k. With that kind of backing, you can easily withstand the highs and lows of practice. If it builds up, there are ways to pay yourself a dividend.

Agreed, and doubly so if you have any employees. You could also look into opening a business line of credit "just in case," but having the case reserves on hand is a safer bet. It could also be tough to open the line of credit unless you have a pre-existing relationship with the bank and/or until you have some business credit or earnings history.

 

[PsynofTimes]

1) That is HIGHLY dependent on the specific insurance policy. There is zero coherence between plans, even under the same insurance company. Medicare might pay for all testing. "ACME Bronze Plus of Random State" might not pay for any psych testing for conditions they don't cover, but "ACME Emerald Plus of Random State" might only pay for 2 units of testing. Reading the provider handbook takes some time, but it is pretty easy to do. Some insurance companies require you to take all their policies, but you can schedule limited availability for that policy.

2) Your NPI taxonomy might affect your ability to get reimbursed. Make sure that your NPI taxonomy matches the other testers in your area.

3) Money: I would HIGHLY recommend that you keep significant cash reserves in your business account. Let's say you net $150k your first year, and you pay yourself $90k. With that kind of backing, you can easily withstand the highs and lows of practice. If it builds up, there are ways to pay yourself a dividend.

Thank you for this! I am looking into getting the provider handbooks now for all the insurances that I will take and make myself a spreadsheet of what they cover. I checked my taxonomy and that seems to be in line with other people's in the area. and good to know about the reserves!

 

[PsynofTimes]

Agreed, and doubly so if you have any employees. You could also look into opening a business line of credit "just in case," but having the case reserves on hand is a safer bet. It could also be tough to open the line of credit unless you have a pre-existing relationship with the bank and/or until you have some business credit or earnings history.

No employees just yet... hopefully I can just get the cash reserves.

 

[WisNeuro]

Agreed, and doubly so if you have any employees. You could also look into opening a business line of credit "just in case," but having the case reserves on hand is a safer bet. It could also be tough to open the line of credit unless you have a pre-existing relationship with the bank and/or until you have some business credit or earnings history.

Third this. At any given time, I keep enough cash in my business accounts to pay my salary and overhead for 4+ months. Also, keep my personal "liquid emergency funds" going at a good 6+ months. And then some semi-liquidable investments that can be pulled from in case of an extended emergency. Contingency plans are good to have once you can fund them. Though, not taking out an absurd amount of loans helps with making this a reality sooner rather than later.

 

[PsynofTimes]

Third this. At any given time, I keep enough cash in my business accounts to pay my salary and overhead for 4+ months. Also, keep my personal "liquid emergency funds" going at a good 6+ months. And then some semi-liquidable investments that can be pulled from in case of an extended emergency. Contingency plans are good to have once you can fund them. Though, not taking out an absurd amount of loans helps with making this a reality sooner rather than later.

Thank you - I think I can do this with hopefully not taking out any loans.

 

[WisNeuro]

Thank you - I think I can do this with hopefully not taking out any loans.

I'd hope not at this point, I was more referring to those who took out an unwise level of loans for their degrees.

 

[PsynofTimes]

I'd hope not at this point, I was more referring to those who took out an unwise level of loans for their degrees.

oh, ok. Thankfully I'm not in that boat either.